Sinossi di revisioni sistematiche sull'efficacia dell'eparina per prevenire le occlusioni nei dispositivi di accesso venoso centrale

Introduction. Prevention of central venous access devices (CVAD) occlusion is crucial to the continuity and quality of care. There is wide consensus on the need to carry out a periodic flushing of the lumen of device in order to ensure its patency. The most commonly used solutions are the heparin solution (HS) and the physiological solution (NaCl 0.9% - PS). There are still controversial opinions on HS's effectiveness over PS. Objective. To evaluate the effectiveness of HS compared to PS to prevent occlusion in CVAD.
Methods. A search strategy on four electronic databases (The Cochrane Library, Medline, Embase, CINAHL) was implemented on April 4, 2017. Records returned were independently analyzed; those complying with inclusion criteria were found in full text. They've been included systematic reviews of RCT or quasi-experimental studies that have compared the use of HS with PS. The quality assessment of reviews was done with AMSTAR checklist.
Results. Seven moderate-high quality systematic reviews met inclusion criteria. HS is was not superior to PS in preventing CVAD occlusions.
Discussion. Reviews included were of high quality methodological. The statistical heterogeneity between RCT was low while the clinical and methodological heterogeneity was high. Conclusions. HS was no longer effective than PS to prevent CVAD occlusions. Waiting for better quality studies to evaluate the overall DAVC management process, it seems reasonable to recommend using PS.