Observational Study of the Effect of Heparin-Containing Flush Solutions on the Incidence of Arterial Catheter Occlusion

Abstract

The National Patient Safety Agency (NPSA) highlighted potential dangers associated with arterial lines in 2008, recommending the use of saline-only flush solutions. The incidence of catheter thrombosis appeared to increase following the implementation of this guidance in some units. The objective of the current study was to observe local practice regarding the use of heparin in arterial catheter flush solutions, and subsequent arterial catheter occlusion rates. This was an observational study in which data were collected prospectively from 445 catheter insertions in unselected intensive care patients in eight member hospitals of the Association of North Western Intensive Care Units (ANWICU). Catheters flushed with heparinised solutions had a significantly increased median lifespan of 102 hours versus 72 hours for saline-flushed catheters (p<0.01). The likelihood of line blockage was significantly decreased in the heparin group (7.9%) compared with the saline group (41.2%, p<0.0001). Our results suggest that routine use of heparinised flush solutions is associated with increased catheter lifespan and reduced catheter thrombosis. We believe that there is justification for an adequately powered, randomised controlled trial. Current NPSA guidance may need to be reviewed.

Catheter-related thrombosis: A practical approach

“…Tully et al performed an observational study of 445 arterial lines flushed with either saline or heparin solutions and found significantly decreased rates of line occlusion with increased catheter lifespan in the heparin group. 35 Whilst there is insufficient evidence to recommend the practice of flushing lines with heparin to maintain line patency at this time, 28,36,37 it is an area that requires further evaluation with adequately powered, blinded randomised controlled trial.…”

The Boston Medical Center Coronavirus Disease 2019 (COVID-19) Procedure Team: Optimizing the surgeon’s role in pandemic care at a safety-net hospital

“…[13][14][15] In response, we implemented continuous infusions of dilute heparin (2 units/mL, infused at a rate of 3 mL/h) as supported by studies demonstrating prolonged catheter patency and lesser rates of thrombosis compared with normal saline. [16][17][18] Several lessons have been gleaned from this experience. Departmental restructuring was necessary to produce the workforce required to consistently staff the Procedure Team.…”

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

“…2 A subsequent multicentre study demonstrated an increased lifespan and a significantly reduced likelihood of blockage in lines flushed with HS. 6 Whilst ours is a single-centred study, the strength of our results lies in our standardisation of equipment, procedures and data collection. We demonstrated an overall cost saving with the use of NS.…”

“…5 In a recent publication, catheters flushed with HS had an increased lifespan and a significantly reduced likelihood of blockage. 6 This prompted suggestion that current debate should not only focus on patient safety but also on the implications of widespread use of NS flushes on patient morbidity.…”