Benefit and risk of heparin for maintaining peripheral venous catheters in neonates: a placebo-controlled trial

Position Statement on Heparin Safety Concerns

“…Heparin is also used for CVL management in neonates, with flush solution concentrations ranging from 1 to 10 units/mL. 8,9 In addition, heparin can be added to neonatal total parenteral nutrition or intravenous (IV) fluids in 0.5-to 1-unit/mL concentrations. Heparin flushes also continue to be used with pediatric patients and surgically placed central catheters (e.g., Broviac [C. R. Bard, Murray Hill, NJ] or Port-a-Cath [Smiths Medical, Ashford, England]) at 10 unit/mL or 100 unit/mL concentrations, with up to 1000 units/mL being used in dialysis catheters.…”

“…2 In pediatric intensive care unit settings, heparin continuous infusions of 1 unit/mL have been shown to decrease phlebitis in peripheral arterial catheters. 5, [8][9][10] In addition to the broad array of heparin storage devices marketed, concentrations available, and volumes used, some heparin products contain preservatives. This can add another layer of complexity to the formulary decision-making process.…”

“…Products that contain benzyl alcohol should not be stocked in areas providing care to patients younger than 1 year old. 1,9 Currently, The Joint Commission has requirements regarding high-risk, high-alert medications and anticoagulants. Some of those requirements, among others, include developing a medication process that integrates storing, dispensing, and monitoring; reduces the likelihood of harm with anticoagulants; and accurately reconciles medications across the continuum of care.…”

Heparin-Induced Thrombocytopenia Screening and Management in Pediatric Patients

“…Three studies in neonates found no cases of HIT or antibody formation associated with the use of low-dose UFH to maintain catheter patency (N ϭ 253 patients). [12][13][14] However, an earlier study demonstrated positive heparin-induced platelet aggregation (HIPA) tests in 41% of infants with thrombocytopenia exposed to heparin (13 of 42 patients). 8 All of these infants were receiving heparin to maintain line patency and were not on a typical treatment dose.…”

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

“…Although this practice is widespread, its clinical utility is controversial. [3][4][5][6][7][8] Heparin is listed as a 'high-alert' medication by the Institute for Safe Medication Practices because of a heightened risk of significant patient harm when used in error. 9 This is underscored by reports of adverse events from heparin in the neonatal period including heparin-induced thrombocytopenia, thrombosis, allergic reactions, drug incompatibility, iatrogenic intracranial hemorrhages in very low-birthweight (birthweight <1500 g) infants, 10,11 increased risk of candidemia 12 and failed response to indomethacin therapy for patent ductus arteriosus.…”