JOPHON NCPD (2023 Jan/Feb) - Pilot Randomized Trial of a Three Times Weekly Heparin Flushing Intervention in Children, Adolescents, and Young Adults With Cancer With Tunneled Central Venous Catheters-ARTICLE: JOPHON CNE (2023 Jan/Feb) - Pilot Randomized Trial of a Three Times Weekly Heparin Flushing

ARTICLE: JOPHON CNE (2023 Jan/Feb) - Pilot Randomized Trial of a Three Times Weekly Heparin Flushing

Pdf Summary

This pilot randomized controlled trial evaluated whether flushing noninfusing tunneled central venous catheters (TCVCs) three times weekly with heparin is feasible compared with the common practice of daily heparin flushing in children, adolescents, and young adults (ages 2–22) with cancer. Because existing flushing guidelines vary widely and are based on low-quality evidence, the study aimed to generate feasibility data to support a larger definitive trial.<br /><br />Conducted at a tertiary children’s hospital in Southern California (2016–2018), 20 of 22 eligible patients enrolled (90% recruitment). Participants were assigned to standard of care (daily flushing) or an intervention (Monday/Wednesday/Friday flushing) for 8 weeks, using 3 mL of heparin (10 units/mL) per lumen. Feasibility outcomes included recruitment, retention, acceptability, catheter patency, and complications. Patency was assessed weekly using a 5-point scale and by tracking need for alteplase.<br /><br />Retention was 80%: four participants discontinued early due to TCVC removal (20% attrition). Removals occurred because of bloodstream infection (one per group), catheter damage (one in standard care), and treatment completion (one in intervention). No participant withdrew due to safety concerns or dissatisfaction with the protocol, indicating good acceptability.<br /><br />Patency outcomes were encouraging: one standard-care participant required alteplase during week 7, while none in the intervention group did, and no catheters were removed due to occlusion. Central line–associated bloodstream infections occurred in both groups (three in standard care, two in intervention), with more mucosal-barrier–injury–attributed infections in standard care.<br /><br />Overall, the study concludes that a larger, multicenter trial comparing less frequent flushing schedules is feasible and could potentially reduce line accesses and caregiver burden while maintaining catheter function.

Keywords

pilot randomized controlled trial

tunneled central venous catheter

heparin flushing frequency

pediatric oncology

catheter patency

central line-associated bloodstream infection

alteplase use

feasibility study

catheter occlusion prevention

caregiver burden reduction