A Comparison of the Efficacy of Heparinized and Nonheparinized Solutions for Maintenance of Perioperative Radial Arterial Catheter Patency and Subsequent Occlusion

Abstract

In a randomized, double-blind, controlled study, we compared heparinized and nonheparinized infusions for the maintenance of perioperative arterial catheter patency and the incidence of subsequent radial arterial occlusion. Two-hundred patients were randomized into 2 groups to receive heparinized (group H, n = 100) or nonheparinized (group S, n = 100) flush solutions. Radial and ulnar blood flows were assessed using Doppler probe and pulse oximetry before, just after, and 24 h after decannulation by the same investigator. The cannulation site was examined for complications such as hematoma, nerve injury, and infection. The mean duration of cannulations was 378 +/- 159.0 min in group H and 332 +/- 154.6 min in group S. The mean number of corrective interventions caused by dampening of the pressure wave (mean number of positional changes [group S, 1.5 +/- 2.0; group H, 1.4 +/- 3.8] and mean number of manual flushes [group S, 1.3 +/- 1.7; group H, 1.2 +/- 1.2]) was not significantly different in both groups. After decannulation, partial or total occlusion developed in 20 group H patients and 16 group S patients (not significant). The incidence of occlusion was correlated to the presence of hematoma at the puncture site after decannulation (P = 0.013), long duration of cannulation (P = 0.04), and age <65 yr (P = 0.009). In conclusion, there is no significant difference between heparinized and nonheparinized flush solutions for the maintenance of perioperative radial artery catheter patency.

Finding a solution: Heparinised saline versus normal saline in the maintenance of invasive arterial lines in intensive care

“…8 Subsequent smaller studies have failed to demonstrate a difference between the two flush solutions. 1,9,10,11 These studies are heterogeneous with variable HS flush concentrations, small sample sizes and inadequate statistical power. A recent Cochrane review summarised current evidence suggesting that NS is comparable to HS for maintaining catheter patency, whilst emphasising the poor quality of existing evidence.…”

“…Maintenance of arterial line patency is essential to reduce patient discomfort, time and financial expense incurred by blocked catheter replacement. 1,2 Multiple factors including catheter flush solution have been shown to influence arterial line patency, with heparinised saline (HS) traditionally being used for its anticoagulant properties. 2 Current evidence regarding flush solution is conflicting, and uncertainty exists as to which solution is best.…”

“…In 2008, the National Patient Safety Agency (NPSA) published a report recommending exclusive use of 0.9% normal saline (NS) as an arterial flush solution: subsequently use of HS in UK adult intensive care units has reduced to 4.6%. 3,4 Despite this, 1 Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK serious errors involving administration of incorrect arterial flush solutions continue to occur. 5 In a recent publication, catheters flushed with HS had an increased lifespan and a significantly reduced likelihood of blockage.…”

Effects of Normal Saline for Maintenance of Arterial Lines of Surgical Patients

“…증 등의 부작용을 일으키는 요인으로도 작용한다고 보고된 바 있 다 (Amiral, 2001;Choi et al, 2007;Cook, 2004) (Aubin, 1979;Bedford, 1978;Tuncali et al, 2005), 혈전증 발생의 50%는 요골동 맥을 사용한 경우로 확인되었다 (Kaye, 1983). …”

When Is Hypertension a True Crisis and How Should It Be Managed in the Intensive Care Unit?

“…8 Although heparinized flush is commonly used to maintain radial artery patency, a recent randomized trial found that it offered no advantage over placebo. 9 Importantly, radial artery pressure may underestimate central arterial pressure in settings that include hypothermia and after cardiopulmonary bypass. 8,10 Hypertensive crises are defined as hypertensive emergencies or hypertensive urgencies.…”