Heparin locks with low and high concentration in haemodialysis patients: A systematic review and meta‐analysis. Issue 1 (21st December 2020)

• Record Type: Journal Article
• Authors: Tan, Jiajia; Ning, Tingting; Zhang, Wenting; Qian, Zhuru; Jiang, Xuqin; Sun, Ling; Wu, Bin
• Is Part Of: International journal of nursing practice. Volume 27:Issue 1(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-12-21
• Subjects: haemodialysis -- heparin -- catheter lock -- meta‐analysis -- review; Nursing -- Periodicals; Nursing -- Practice -- Periodicals; 610.73092
• DOI: 10.1111/ijn.12907
• Languages: English
• ISSNs: 1322-7114

Abstract

Abstract: Aim: There is no evidence‐based consensus on the optimal concentration for heparin locks; several randomized controlled trials (RCTs) have evaluated the concentration of heparin locks, yet the results remain inconsistent. We aimed to assess heparin locks with low and high concentration in haemodialysis patients. Methods: We performed a systematic review and meta‐analysis of RCTs focusing on the concentration in heparin locks. Studies were identified by searching PUBMED, EMBASE, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI) and Wanfang databases (from inception to 15 March 2020). Summary risk ratios or mean differences with 95% confidence interval were calculated. Results: A total of 370 patients with four RCTs were included. Heparin locks with 1000 U/ml could significantly reduce the activated partial thromboplastin time (APTT) compared with 5000 U/ml. No significant differences were seen in the occurrence of catheter‐related thrombosis, the length of catheter stay, the rates of bleeding and catheter occlusions between the two groups. Conclusions: Lower concentrations in heparin lock are optimal for shortening APTT in haemodialysis patients; further studies are needed to elucidate the role of heparin concentration in the lock practice. SUMMARY STATEMENT: What is already known about this topic? Heparin locks are highly recommended for reducing catheter‐related complications, yet no evidence‐based consensus has been achieved on the optimal concentration for heparin locks. One thousand‐ and 5000‐U/ml heparin are commonly used for locking by nurses in haemodialysis patients. What this paper adds? Heparin locks with lower concentration are more beneficial to reduce activated partial thromboplastin time (APTT) compared with higher concentration. The implications of this paper: Heparin locking with lower concentration (1000 U/ml) is a better option for clinical nursing in patients with haemodialysis.