Firenze 4-5-6 dicembre 2017 Palazzo dei Congressi Convegno internazionale organizzato da GAVeCeLT Gruppo Aperto Gli Accessi Venosi Centrali a Lungo Termine GAVeCeLT 2017 X Congresso GAVeCeLT XI PICC Day Prevenzione delle occlusioni: tramonto della eparinizzazione Sergio Bertoglio Dipartimento Scienze Chirurgiche UNIGe Ospedale Policlinico San Martino - Genova
Lecturer and/or Consultancy agreements with: Bard Baxter Becton Dickinson BMR DEKRA Plan 1 Health
RATIONALE FOR LOCKING VASCLUAR DEVICES WITH HEPARINIZED SALINE SOLUTION Reduces platelet aggregation Prevents intraluminal catheter cloth No reduction on CR-DVT rates CERTAINLY TRUE Biofilm formation Decreases CLASBI incidence?
In vitro formation of S.aureus MZ 1000 biofilm on polystirene abiotic surfaces with or without heparin
POSSIBLE SIDE EFFECTS OF HEPARIN LOCK SOLUTIONS Drug incompatibility ( antibiotics, meperidine, prometazine)
POSSIBLE SIDE EFFECTS OF HEPARIN LOCK SOLUTIONS Since more than two decades heparin has been eliminated for peripheral catheters flush and lock procedures Since the 90 there is a wide range of literature supporting the non inferior efficacy of normal saline
THE HEPARIN SOLUTION CONTROVERSY ; WHAT ABOUT LONG-TERM VASCULAR ACCESS DEVICES?
OVERALL SURVIVAL FREE FROM OCCLUSIVE EVENTS P=.907
STUDY LIMITATIONS RETROSPECTIVE COHORT STUDY NOT RANDOMISED
NS(%) HS(%) R.R Easy injection+ Withdrawal occlusion 3.70 3.92 0.94 Injection problems 0.40 0.81 0.50 Aspiration problems 5.57 5.86 0.92 DVT 2.8 3.3 NA CRBSI * 0.5 1.5 * p = 0.18 Per 1000 cath/days* 0.03 0.10
CONCLUSIONS Heparin lock can be safely omitted The non inferiorirty of NS versus heparin solutions may support the decision to evolve to heparin-free hospitals for catheter management
OVERVIEW OVER RECENT GUIDELINES POSITION
VOLUME 31 NUMBER 10 APRIL 1 2013 JOURNAL OF CLINICAL ONCOLOGY A S C O S P E C I A L A R T I C L E Central Venous Catheter Care for the Patient With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Charles A. Schiffer, Pamela B. Mangu, James C. Wade, Dawn Camp-Sorrell, Diane G. Cope, Bassel F. El-Rayes, Mark Gorman, Jennifer Ligibel, Paul Mansfield, and Mark Levine See accompanying article in J Oncol Pract doi:10.1200/jop.2012.000780
FEBRUARY 2016
NATIONAL INTALIAN CONSENSUS POSITION ON LOCK SOLUTIONS 2016 Nov 2;17(6):453-464.
QUESTIONS 1-4 IS THERE A ROLE FOR ANTICOAGULANTS TO PREVENT CATHETER OCCLUSION? QUESTIONS 5-7 IS THERE A ROLE FOR ANTIMICROBIAL AGENTS TO PREVENT COLONIZATION OR CR-BSI?
PANEL POSITION Question 3 Q.3 - Is there evidence that lock with normal saline might be as appropriate as an anticoagulant lock, in terms of prevention of lumen occlusion? PANEL RECOMENDATION Saline lock is as appropriate as anticoagulant lock in prevention of occlusion of NonDCVA
CONCLUSIONI LE EVIDENZE CLINICHE SONO FAVOREVOLI ALL ABBANDONO DELLE SOLUZIONI EPARINATE PER LE PROCEDURE DI LOCK DEI CATETERI VASCOLARI ANCHE A LUNGO TERMINE HEPARINIZE D SOLUTION NORMAL SALINE
LAVAGGIO PULSATILE MECCANICO PREVENZIONE REFLUSSO SIRINGHE PRE CARICATE IDONEE BIOFILM PREVENZIONE CLABSI NESSUN EFFETTO SPECIFICO
POSSIBILE SCENARIO FUTURO PER UN LOCK IDEALE Necessari studi clinici controllati TAUROLIDINE ETHANOL CITRATE EDTA METHYLEN BLUE
sergio.bertoglio@unige.it