Heparinised Saline versus Normal Saline in Maintaining Patency of Arterial and Central Venous Catheters

Abstract

Introduction: Heparin has been used in flush solutions in attempts to prolong the patency of arterial and central venous pressure monitoring lines. Its use however is not without risks such as hypersensitivity reactions and heparin-induced thrombocytopenia. Recent studies suggest that non-heparinised solutions may be as effective in maintaining catheter patency. Our aim is to determine if there is any difference in maintaining patency of arterial and central venous pressure monitoring lines using normal saline as compared to heparinised saline. Methods: In this randomised controlled trial, patients were randomised to receive either heparinised saline or normal saline flush solutions. Randomisation was achieved using sealed opaque envelopes. Only nurses who had been specially trained in the care of catheters cared for the lines. Data was collected at 8-hour intervals for up to 120 hours post-insertion on acceptability of arterial waveform and presence of backflow of blood in the arterial and central venous lines. Results: A total of 70 patients were enrolled, with 36 in the normal saline group and 34 in the heparinised saline group. There were no differences between the groups in functionality of the arterial catheters as determined by waveform and backflow at 72 hours (p=0.578) and 120 hours (p=0.328) as well as for the venous catheters at 72 hours (p=0.063) and at 120 hours (p=0.173) based on presence of backflow. Conclusion: Normal saline is as effective as heparinised saline as flush solutions. Eliminating heparin use in flush solutions will result in fewer potential adverse events and cost savings.

Comparison of Arterial Line Patency in Heparinized Normal Saline with Normal Saline Flushing Among Critically ill Patients: A Literature Review

“…Likewise, arterial line treatment protocols are increasingly developing (Ishii et al, 2021). The results of these studies also stated that the patency of the catheter was not determined by the presence or absence of an anticoagulation agent but was determined by the constant flushing of the fluid (Goh et al, 2011).…”

“…In the group that was given flushing heparin with normal saline, the interventions carried out in each study were different, especially regarding the ratio of heparin and normal saline doses, which was 1:1 (Goh et al, 2011;Xiong et al, 2019) 2:1 (Han et al, 2012;Ishii et al, 2021), 6:1 (Tamura et al, 2021), and 10:1 (Alizadehasl et al, 2015;Ziyaeifard et al, 2015). In terms of research outcomes, five articles discussed the duration of arterial line patency.…”

The effect of an intermediate dose of Heparin solution in the Prevention of Central Venous Catheter occlusion on ICU admitted patients: A randomized Controlled Trial

“…Therefore, are widely used for the maintenance of catheters (8). However, its efficacy is not well understood and the use of Heparinized saline solution also has potential risks such as coagulation disorders, hypersensitivity reactions, and heparin-associated thrombocytopenia (HIT) (9,10). The concentration of heparin used varies between 10 and 1000 units per milliliter (8).…”