Originally published as JCO Early Release 10.1200/JCO.2008.19.4860 on March 9 2009

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Prospective, Randomized Trial of Two Different Modalities of Flushing Central Venous Catheters in Pediatric Patients With Cancer

From Pediatric Hematology and Oncology; and Pediatric Surgery, Department of Pediatrics, University of Padova; and Microbiology and Virology; and Anesthesiology and Intensive Care Unit, Azienda Ospedaliera of Padova, Padova, Italy.

Corresponding author: Simone Cesaro, MD, Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, Padova, Italy 35128; e-mail: simone.cesaro{at}unipd.it.

Purpose There are limited prospective data on whether the method of flushing affects the complication rate of tunnelled central venous catheters (CVCs).

Patients and Methods During a 25-month period, 203 pediatric patients who had newly placed Broviac-Hickman CVCs were randomly assigned to standard flushing with heparin solution or to experimental flushing with normal saline via a positive-pressure cap.

Results Two hundred twenty-one complications were recorded among 75,249 CVC-days (2.94 per 1,000 CVC-days). A higher incidence of CVC occlusion (83 v 41 episodes; P = .0002) and bacteremia (24 v 9; P = .01) were found in the experimental arm. The cumulative probability of developing at least one CVC complication was higher in the experimental arm than in the standard arm (65.1% [95% CI, 55% to 75%] v 43.8% [95% CI, 34% to 54%], respectively; P = .01). No difference was found in either the cause or the frequency of premature removal of CVCs between the two study arms. After a median follow-up of 360 days (range, 4 to 1,073), CVC survival was similar: 77% (95% CI, 66% to 84%) for the experimental arm and 69% (95% CI, 53% to 80%) for the standard arm (P = .7). The factors associated with the occurrence of CVC complication were a diagnosis of leukemia/lymphoma, double-lumen CVC, and experimental flushing. The only factor significantly associated with premature removal of a CVC was a diagnosis of leukemia/lymphoma (hazard rate, 2.3; 95% CI, 1.1 to 4.7).

Conclusion An increased complication rate was found with normal saline flushing, but additional investigation is warranted to clarify whether it is related to saline use or to once-a-week flushing.

Supported in part by Grants No. 1-03 and 1-04 from the Italian Association of Leukemia and Lymphoma section of Padova.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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