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Andrew B. Kairalla MD, Editor
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Heparin for PCVC Infusions
Shah PS, Kalyn A, Satodia P, et al. A Randomized, Controlled Trial of Heparin Versus Placebo Infusion to Prolong the Usability of Peripherally Placed Percutaneous Central Venous Catheters (PCVCs) in Neonates: The HIP (Heparin Infusion for PCVC) Study. PEDIATRICS (January 2007); 119:e284-e291. [Full text] [PDF]
OBJECTIVE. Our goal was to evaluate the effectiveness of heparin in prolonging the usability of peripherally inserted central venous catheters in neonates.
DESIGN/METHODS. We performed a multicenter, randomized, controlled trial of heparin infusion (0.5 U/kg per hour) versus placebo for peripherally inserted central venous catheters in neonates. The primary outcome was duration of catheter use. Secondary outcomes were occlusion, catheter-related sepsis, thrombosis, and adverse effects of heparin. To detect a 168-hour (1-week) difference in the duration of catheter use, 192 patients were needed. Kaplan-Meier and Cox regression analyses were performed.
RESULTS. A total of 201 neonates were enrolled (heparin group: n = 100; control group: n = 101). Baseline demographics were similar between the groups. Duration of catheter use was longer in the infants in the heparin versus the placebo group. Study center, gender, birth weight, and type and position of the catheter were not predictors of duration of catheter use. For those in the heparin versus the placebo group, the incidence of elective catheter removal (therapy completed) was 63% vs. 42%, of occlusion was 6% vs. 31%, of thrombosis was 20% vs. 21%, and of catheter-related sepsis was 10% vs. 6%, respectively. No adverse events were noted.
CONCLUSIONS. Heparin infusion prolonged the duration of peripherally inserted central venous catheter usability, which permitted a higher percentage of neonates to complete therapy without increasing adverse effects.
Comments: Too bad! I was really hoping that we would find
that heparin was not helpful in prolonging the life of PCVCs. This high-risk
medication can cause very serious consequences when dosing errors occur. The
results of this study are in contrast to 2 previous studies that showed no
benefit to adding heparin to PCVC infusates. One of the differences in this
study was that the larger sample size improved the power to detect smaller
changes with statistical significance. Another difference was that the dose
and concentration of heparin infused was based on the weight of the patient
(0.5 units/kg/hr). The heparin was also given by “piggy back” infusion rather
than being mixed with the TPN. I’m still not convinced that the benefit
outweighs the risks when using heparin for PCVC patency. ABK.
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