A randomized trial of heparin and saline for maintaining intravenous locks in neonates

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

BACKGROUND

It is still controversial for neonates or children to choose normal saline or heparin solution in the care of peripheral intravenous catheters. This meta-analysis aimed to evaluate the effects of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics, to provide reliable evidence support for clinical care.

METHODS

Two authors searched the PubMed, EMbase, Ovid Medline, Cochrane Library, Web of Science, CBM, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics until July 16, 2023. The bias of risk tool recommended by Cochrane was used for the quality evaluation of included RCTs. Meta-analysis was carried out by using RevMan 5.4 software.

RESULTS

A total of 22 RCTs involving 3988 peripheral intravenous catheters were finally included. Compare with normal saline, heparin could significantly increase the catheter indwelling time (MD = 9.10, 95%CI:3.30 ~ 14.90). Subgroup analysis indicated that for compare with normal saline, heparin could significantly increase the catheter indwelling time in the neonate (MD = 9.63, 95%CI: 0.38 ~ 18.88) and neonate + children population (MD = 6.22, 95%CI:2.72 ~ 9.73, P < 0.001). Heparin could significantly reduce the incidence of catheter-associated complications (RR = 0.84, 95%CI: 0.70 ~ 0.95). Subgroup analysis indicated that heparin could significantly reduce the incidence of catheter-associated complications in the neonate (RR = 0.70, 95%CI: 0.61 ~ 0.89). There was no publication bias amongst the synthesized outcomes by Egger's test (all P > 0.05).

CONCLUSIONS

Heparin may be worthy of being applicated in the neonate population in terms of prolonged indwelling time and less complications. Limited by the evidence quality, more studies from different area and populations with rigorous design are needed to investigate the role of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics.

Necessity of heparin for maintaining peripheral venous catheters: A systematic review and meta-analysis

Heparin has typically been used as a flushing or infusion solution for vascular lines in daily practice. However, several clinical trials have yielded controversial results about the benefits of heparin in maintaining peripheral venous catheters. The present meta-analysis was conducted to evaluate the efficacy of heparin on the patency profiles and complications in peripheral intravenous catheters. PubMed, Embase and Cochrane Central Register of Controlled Trials were searched up to February 2016 for randomized controlled trials comparing heparin with placebo in maintaining peripheral intravenous catheters. Additional studies were retrieved from the reference lists of identified articles. In total 32 eligible studies were included, from which the pooled standard mean difference (SMD), relative risk (RR) and corresponding 95% confidence interval (CI) were calculated. The use of heparin as a continuous infusion significantly prolonged the duration of patency (SMD, 0.90; 95% CI, 0.48-1.32; P<0.001), reduced rates of infusion failure (RR, 0.83; 95% CI, 0.76-0.92; P<0.001) and occlusion (RR, 0.82; 95% CI, 0.69-0.98; P<0.05) in a peripheral intravenous catheter. However, there were no significant changes in the duration of patency and infusion failure when heparin was used intermittently as a flushing solution, although a significantly decreased risk of occlusion was observed in this setting (RR, 0.80; 95% CI, 0.66-0.98; P<0.05). Furthermore, the risk of phlebitis was significantly decreased by both continuous infusion (RR, 0.66; 95% CI, 0.58-0.75; P<0.01) and intermittent flushing (RR, 0.70; 95% CI, 0.56-0.86; P<0.01) of heparin in peripheral venous catheters. In conclusion, the use of heparin as continuous infusion in peripheral intravenous catheters improved the duration of patency, reduced infusion failure and phlebitis, whereas heparin as intermittent flushing showed more benefits in ameliorating phlebitis rather than in patency profiles.

Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial

OBJECTIVE

Recent evidence supports the use of normal saline flushes in place of heparin to maintain the patency of peripheral intravenous locks (IVLs); however, there are no data regarding the recommended flush frequency.

STUDY DESIGN

This was an open, non-inferiority, randomised controlled trial. Children with IVLs, aged 1-17 years, were randomly assigned to receive saline flushing every 12 h (group A) or every 24 h (group B). The main outcome was the maintenance of catheter patency.

RESULTS

Four hundred patients were randomised; 198 subjects were analysed in the 12 h group and 199 in the 24 h group (three patients were lost at follow-up). Occlusion occurred in 15 children (7.6%) in group A versus 9 (4.5%) in group B (p=0.21). The difference in catheter patency was +3.1% in favour of the 24 h group (95% CI -1.6% to 7.7%), showing the non-inferiority of the 24 h procedure (the non-inferiority margin was set at -4%). Catheter-related complications were not different between the two groups (12.1% in group A vs 9.5% in group B; p=0.42).

CONCLUSIONS

A flushing procedure with one flush per day allows maintenance of catheter patency without an increase in catheter-related complications. We propose a simplification of the flushing procedure with only one flush per day, thereby reducing costs (materials use and nursing time), labour and unnecessary manipulation of the catheters which can cause distress in younger children and their parents.

TRIAL REGISTRATION NUMBER

The study is registered in the international database ClinicalTrial.gov under registration number NCT02221024.

Heparin for prolonging peripheral intravenous catheter use in neonates: a randomized controlled trial

OBJECTIVE

To determine the efficacy of heparinized saline administered as intermittent flush on functional duration of the peripheral intravenous catheter (PIVC) in neonates.

STUDY DESIGN

Randomized, double-blind and placebo-controlled trial.

SETTING

Neonatal intensive care unit of a teaching hospital.

PARTICIPANTS

Term and preterm neonates born at >32 weeks of gestation who required PIVC only for intermittent administration of antibiotics.

INTERVENTION

Eligible neonates were randomized to receive 1 ml of either heparinized saline (10 U ml(-1)) (n=60) or normal saline (n=60) every 12 h before and after intravenous antibiotics.

MAIN OUTCOME MEASURE

Functional duration of first peripheral intravenous catheter.

RESULT

A total of 120 neonates were randomized to two groups of 60 neonates each. The mean (s.d.) of age of babies in case and control group was 5.7 (2.5) days and 4.6 (3.1) days, respectively. The average weight of babies in both the groups was 2.1 kg. Mean functional duration of first catheter was more in heparinized saline group, mean (s.d.) of 71.68 h  (27.3) as compared with 57.7 h (23.6) in normal saline group (P<0.005). The mean (95% confidence interval) difference in functional duration in the two groups was 13.9 h (4.7-23.15). Mean duration of patency for any catheter was also significantly more in heparinized saline group than control group.

CONCLUSION

Heparinized saline flush increases the functional duration of peripheral intravenous catheter.

Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults

BACKGROUND

Heparin intermittent flushing is a standard practice in the maintenance of patency in central venous catheters. However, we could find no systematic review examining its effectiveness and safety.

OBJECTIVES

To assess the effectiveness of intermittent flushing with heparin versus 0.9% sodium chloride (normal saline) solution in adults with central venous catheters in terms of prevention of occlusion and overall benefits versus harms.

SEARCH METHODS

The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched December 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11). Searches were also carried out in MEDLINE, EMBASE, CINAHL and clinical trials databases (December 2013).

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults 18 years of age and older with a central venous catheter (CVC) in which intermittent flushing with heparin (any dose with or without other drugs) was compared with 0.9% normal saline were included. No restriction on language was applied.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, assessed trial quality and extracted data. Trial authors were contacted to retrieve additional information, when necessary.

MAIN RESULTS

Six eligible studies with a total of 1433 participants were included. The heparin concentrations used in these studies were very different (10-5000 IU/mL), and follow-up varied from 20 days to 180 days. The overall risk of bias in the studies was low. The quality of the evidence ranged from very low to moderate for the main outcomes (occlusion of CVC, duration of catheter patency, CVC-related sepsis, mortality and haemorrhage at any site).Combined findings from three trials in which the unit of analysis was the catheter suggest that heparin was associated with reduced CVC occlusion rates (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.29 to 0.94). However, no clear evidence of a similar effect was found when the results of two studies in which the unit of analysis was the participant were combined (RR 0.21, 95% CI 0.03 to 1.70), nor when findings were derived from one study, which considered total line accesses (RR 1.08, 95% CI 0.84 to 1.40). Furthermore, results for other estimated effects were found to be imprecise and compatible with benefit and harm: catheter duration in days (mean difference (MD) 0.41, 95% CI -1.29 to 2.12), CVC-related thrombosis (RR 1.22, 95% CI 0.74 to 1.99), CVC-related sepsis (RR 1.02, 95% CI 0.34 to 3.03), mortality (RR 0.77, 95% CI 0.45 to 1.32) and haemorrhage at any site (RR 1.37, 95% CI 0.49 to 3.85).

AUTHORS' CONCLUSIONS

We found no conclusive evidence of important differences when heparin intermittent flushing was compared with 0.9% normal saline flushing for central venous catheter maintenance in terms of efficacy or safety. As heparin is more expensive than normal saline, our findings challenge its continued use in CVC flushing outside the context of clinical trials.

Heparin solution for maintaining peripheral venous catheter patency in children: a survey of current practice in Italian pediatric units

BACKGROUND

Prolonging the duration of peripheral venous catheters (PVC) as long as possible in children is a nursing priority. However, available studies provide conflicting evidence on what kind of flush/lock solution should be used to increase the life of PVCs in children.

OBJECTIVES

To describe the clinical behavior of nurses working in Italian pediatric units with regards to PVCs flushing and locking practices.

METHODS

Cross-sectional study. Nurses were invited to participate using the network of the Italian Society of Pediatric Nursing Science. Those participating completed an online questionnaire available on a website established for this specific purpose. Results: 405 questionnaires were completed.

RESULTS

The majority of nurses reported using Normal saline solution (NS) to flush 22 gauge PVCs: 77.6% in children up to 6 months of age, 74.7% in children 6 months to 2 years, and 74.6% in children over 2 years. Nurses tend to use heparin solutions (HS) more frequently when a smaller gauge PVC is used (24 instead of 22) and when access is less frequent. The use of HS for PVC lock is more common in onco-hematology units (54.5% in children over 6 months with 24 gauge PVC), pediatric surgery units (35%), and in short-stay units (55.6%), whereas NS is used more frequently in Intensive care units (9.4%) and neonatology units (12.2%).

CONCLUSION

Although the majority of respondents use NS, we found a high variability in practices among Italian nurses. More research on the effectiveness and safety of HS in maintaining the patency of PVCs is needed.

Low-dose heparin use and the patency of peripheral IV catheters in children: a systematic review

OBJECTIVE

To assess evidence from randomized controlled trials (RCTs) on the efficacy of low-dose heparin for prolonging patency of peripheral intravenous (PIV) catheters in the pediatric population.

METHODS

We searched Medline, Embase, CINAHL, and Cochrane Central Register of Controlled Trials to identify studies up to June 6, 2012. Additional citations were retrieved from the bibliography of selected articles. The eligible studies were RCTs of low-dose heparin used in PIV catheters as compared with control and measured any one of the following outcomes: duration of catheter patency, infusion failure rates, or phlebitis. Data were extracted by 1 reviewer by using a standardized form and checked for accuracy by a second reviewer. Discrepancies were resolved by consensus.

RESULTS

Thirteen RCTs were identified (3 RCTs of continuous infusion and 10 RCTs of intermittent flush). Catheters using heparin had longer patency (mean difference [95% confidence interval]: 26.51 hours [2.37 to 50.65], P < .001, for the infusion studies and 2.82 hours [-0.04 to 5.67], P = .05, for intermittent flush studies). Heparin usage also resulted in a lower rate of infusion failure (rate ratio [95% confidence interval]: 0.78 [0.62 to 0.99], P = .04, for the infusion studies and 0.88 [0.72 to 1.09], P = .25, for intermittent flush studies). Lower phlebitis rates were also observed with heparin usage; however, the results did not reach significance. There was no increase in heparin-related side effects noted.

CONCLUSIONS

Low-dose heparin as continuous infusion in PIV catheters resulted in clinically significant benefits in terms of catheter patency and fewer episodes of infusion failures. Heparin's use in intermittent flush solutions showed minimal benefits.

Examining the effectiveness of 2 solutions used to flush capped pediatric peripheral intravenous catheters

An evidence-based study examined the effectiveness of 2 solutions, heparin and normal saline, when used to flush capped pediatric peripheral intravenous (CPP IV) catheters. This experimental study assessed patency, redness, swelling, clotting, bruising, leakage, and patient pain after each intervention/flush. Study participants included 62 children (32 heparin and 30 normal saline) who had CPP IV catheters using 20-, 22-, or 24-gauge catheters. No statistically significant differences were found in IV catheter patency between children in the normal saline group and children in the heparin group. A postimplementation follow-up study with 30 patients who received normal saline only as a flush experienced no patency issues.

Reduction in coagulase-negative staphylococcus infection rates in the NICU using evidence-based research

Coagulase-negative Staphylococcus (CoNS) bloodstream infection is the most common cause of sepsis in the NICU and can lead to significant morbidity and mortality. There is evidence that hand hygiene using an alcohol-based gel and wearing gloves during patient care, management of central and peripheral intravenous lines using the Centers for Disease Control and Prevention (CDC) guidelines, and a closed medication administration system can reduce the incidence to CoNS sepsis in the (NICU). To successfully apply the evidence and decrease the CoNS infection rate, a systematic process is necessary. One approach to process change that significantly reduced the CoNS infection rate in a health care system with two Level III NICUs included using system thinking; working within a multidisciplinary team; using evidence to revise, develop, and implement policies and procedures; developing staff education programs; and monitoring and providing feedback to all staff members.

Effectiveness of heparin solution versus normal saline in maintaining patency of intravenous locks in neonates: a double blind randomized controlled study

AIM

The aim of this study was to evaluate the effect of heparin versus saline as flush solution for maintaining patency in peripheral intravenous locks in neonates and to investigate whether other variables influence the longevity of intravenous locks.

BACKGROUND

Heparin is usually used as a regular flush solution to prevent occlusion of peripheral intravenous locks in neonates. There is no clear recommendation using heparin or saline flushing peripheral intravenous locks in neonates. The disadvantage of heparin cannot be ignored, especially in this patient group.

METHODS

In a double blind prospective randomized study, neonates (gestational age >27 weeks) with intravenous locks were randomly assigned to receive heparin or saline as a flush solution in a 21-month period (2002-2004). The main outcome was the duration of patency.

RESULTS

Eighty-eight neonates were included. No statistically significant difference was found in patency of peripheral intravenous locks flushed with 0.7 mL heparin (10 units/mL) (N = 42, median 56 hours) or 0.7 mL saline (N = 46, median 61 hours). When the analysis was confined to removed locks because of non-elective events, no statistically significant difference was found in duration of patency (P = 0.27).

CONCLUSION

As no difference in patency could be established, using saline as a flush solution is preferable to heparin in peripheral intravenous locks in neonates, given the greater likelihood of complications associated with heparin. Although these data are more than 5 years old, the relevance of the outcome is still important for the clinical practice because of the potential adverse effects of heparin in these vulnerable infants.

Heparinized saline vs normal saline for maintenance of intravenous access in neonates: an evidence-based practice change

PURPOSE

To design, implement, and to evaluate the outcomes of an evidence-based practice change regarding the use of heparin in intravenous (IV) locks to improve patient safety. Phase I of the project examined dwell time, hours of patency, gestational age at birth and at time of IV lock insertion, birthweight and weight at time of insertion, and reason for discontinuation for IV access devices prior to and following the practice change from heparinized saline (HS) to normal saline (NS) flush. Phase II of the project was to determine the effect of the educational program on staff knowledge of the use of heparinized saline vs normal saline flushes.

SUBJECTS

The setting was an 18 bed level III NICU located in the northeastern United States. A sample of 70 infants with IV locks were included in the study; HS (n = 34) and NS (n = 36) respectively. Infants with IV's that were converted to IV locks were excluded. Only professional NICU staff (n = 40) were recruited for the educational offering.

DESIGN

A comparative descriptive design with two components was utilized.

METHODS

A retrospective and prospective chart review was used to compare the outcomes of neonates with IV locks flushed with heparin and normal saline flush and evaluated the outcomes. A pretest/posttest design was used to analyze the change of the NICU staff's knowledge concerning heparin flush before and after an educational offering.

MAIN OUTCOME MEASURES

IV lock patency after practice change to NS flush and the change of the NICU staff's knowledge concerning heparin flush after an educational offering.

PRINCIPAL RESULTS

There was a statistically significant difference in IV catheter patency with NS flushed catheters averaging 13 hours longer than HS flushed catheters (p = 0.02). Also a statistically significant increase in mean scores was noted for the NICU staff posttest after the educational offering (p = .0001). There was a 20% increase in knowledge scores.

CONCLUSIONS

Findings from this project support the current literature base suggesting that the use of heparin is unnecessary for the maintenance of IV access devices. Unnecessary exposure of neonates to heparin increases risk to patient safety and should therefore be avoided. Future research should examine the use of heparin in central lines in neonates. Findings additionally support educating staff prior to practice changes.

A randomized controlled trial for maintaining peripheral intravenous lock in children

The most effective and safe method of maintaining peripheral intravenous lock in children is an important clinical question that has been identified by the researchers. The results of recent studies comparing saline versus 10 units/ml of heparin saline flush using a 24-gauge catheter in neonatal and pediatric populations are conflicting and inconclusive. The objectives of this study were to evaluate the effectiveness and safety of three flush solutions: normal saline, 1 unit/ml of heparin saline and 10 units/ml of heparin saline for maintaining peripheral intravenous locks in children, and to establish a research-based practice in the study hospital. In a prospective, randomized controlled, double-blind trial, one hundred and twenty-three subjects ranging in age from 1-10 years with 123 intravenous locks were randomly chosen to receive 1 unit/ml of heparin saline, 10 units/ml of heparin saline and normal saline to evaluate length of catheter use, survival rate and incidence of intravenous complications. The study found no statistically significant differences in length of catheter use, estimated catheter survival and the incidence of intravenous complications among the three groups. The group that received 1 unit/ml of heparin saline demonstrated the highest rate of survival. The mean length of catheter use of the group that received 1 unit/ml of heparin saline (49.8 hours) was 17 hours longer than the group that received normal saline (32.5 hours). There are no significant differences among the three types of flushing solution in terms of the catheter longevity and incidence of intravenous complications.

How Often Should Peripheral Intravenous Catheters in Ambulatory Patients Be Flushed?

Ambulatory intravenous (IV) treatment is frequently prescribed to be administered every 24 hours. Institutional protocols commonly recommend flushing catheters every 8 hours. The authors sought to identify whether flushing more than once every 24 hours conferred any benefit. A retrospective review compared complication rates of different catheter flushing intervals for patients receiving IV therapy. This study investigated 111 courses of treatment for 63 patients. In 43% of the patients (48/111), complications were identified during the treatment period. Complications were less common with flushing every 24 hours (39/99, 39.4%) than with more frequent flushing (9/12, 75%) (P = .021). Indwelling peripheral IV catheters flushed once every 24 hours appear to have lower complication rates than those flushed 2 or 3 times a day.

Heparin for prolonging peripheral intravenous catheter use in neonates

BACKGROUND

Peripheral intravenous (PIV) catheters are widely used in modern medical practice. However, mechanical or infectious complications often necessitate their removal and/or replacement. Heparin has been shown to be effective in prolonging the patency of peripheral arterial catheters and central venous catheters, but may result in life threatening complications, especially in preterm neonates.

OBJECTIVES

The primary objective was to determine the effectiveness of heparin versus placebo or no treatment on duration of PIV catheter patency, defined as number of hours of catheter use. The secondary objectives were to assess the effects of heparin on catheter blockage, phlebitis or thrombophlebitis, catheter related sepsis, and complications including abnormality of coagulation profile, allergic reactions to heparin, heparin induced thrombocytopenia, intraventricular/intracranial hemorrhage and mortality.

SEARCH STRATEGY

A literature search was performed using the following databases: MEDLINE (1966-February 2005), EMBASE (1980-February 2005), CINAHL (1982-February 2005), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005), and abstracts from the annual meetings of the Society for Pediatric Research, American Pediatric Society and Pediatric Academic Societies published in Pediatric Research (1991-2004). No language restrictions were applied.

SELECTION CRITERIA

Randomized or quasi-randomized trials of heparin administered as flush or infusion versus placebo or no treatment were included. Studies which included a neonatal population and reported on at least one of the outcomes were included.

DATA COLLECTION AND ANALYSIS

The methodological quality of the studies was assessed using criteria for blinding of randomization, blinding of intervention, completeness of follow-up and blinding of outcome assessment. Data on relevant outcomes were extracted and the effect size was estimated by calculating WMD (weighted mean difference, 95%CI), RR (relative risk, 95% CI) and RD (risk difference, 95% CI).

MAIN RESULTS

Ten eligible studies were identified. Heparin was administered either as a flush solution, or as an additive to the total parenteral nutrition solution. Five studies reported data on the duration of use of the first catheter. Two of these studies found no statistically significant effect of heparin; two studies showed a statistically significant increase and one study showed a statistically significant decrease in the duration of PIV catheter use in the heparin group. The results were not combined for meta-analysis due to significant heterogeneity of the treatment effect (p < 0.01). In addition, there were marked differences between the studies in terms of the methodological quality, the dose, the timing, the route of administration of heparin and the outcomes reported. From a limited number of studies, there were no significant differences between the heparin and the placebo/no treatment groups in the risks of infiltration, phlebitis and intracranial hemorrhage.

IMPLICATIONS FOR PRACTICE

The effect of heparin on the duration of peripheral intravenous catheter use varied across the studies. Because of clinical heterogeneity and heterogeneity in treatment effect, recommendations for heparin use in neonates with PIV catheters cannot be made.

IMPLICATIONS FOR RESEARCH

There are insufficient data concerning the effect of heparin for prolonging PIV catheter use in neonates. Further research on the effectiveness, the optimal dose, and the safety of heparin is required.

Heparin for prolonging peripheral intravenous catheter use in neonates

BACKGROUND

Peripheral intravenous (PIV) catheters are widely used in modern medical practice. However, mechanical or infectious complications often necessitate their removal and/or replacement. Heparin has been shown to be effective in prolonging the patency of peripheral arterial catheters and central venous catheters, but may result in life threatening complications, especially in preterm neonates.

OBJECTIVES

The primary objective was to determine the effectiveness of heparin versus placebo or no treatment on duration of PIV catheter patency, defined as number of hours of catheter use. The secondary objectives were to assess the effects of heparin on catheter blockage, phlebitis or thrombophlebitis, catheter related sepsis, and complications including abnormality of coagulation profile, allergic reactions to heparin, heparin induced thrombocytopenia, intraventricular/intracranial hemorrhage and mortality.

SEARCH STRATEGY

A literature search was performed using the following databases: MEDLINE (1966-December 2001), EMBASE (1980-December 2001), CINAHL (1982-December 2001), Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), and abstracts from the annual meetings of the Society for Pediatric Research, American Pediatric Society and Pediatric Academic Societies published in Pediatric Research (1991-2001). No language restrictions were applied.

SELECTION CRITERIA

Randomized or quasi-randomized trials of heparin administered as flush or infusion versus placebo or no treatment were included. Studies which included a neonatal population and reported on at least one of the outcomes were included.

DATA COLLECTION AND ANALYSIS

The methodological quality of the studies was assessed using criteria for blinding of randomization, blinding of intervention, completeness of follow-up and blinding of outcome assessment. Data on relevant outcomes were extracted and the effect size was estimated by calculating WMD (weighted mean difference, 95%CI), RR (relative risk, 95% CI) and RD (risk difference, 95% CI).

MAIN RESULTS

Eight eligible studies were identified. Heparin was administered either as a flush solution or as an additive to the total parenteral nutrition solution. Five studies reported data on the duration of use of the first catheter. Two of these studies found no statistically significant effect of heparin; two studies showed a statistically significant increase and one study showed a statistically significant decrease in the duration of PIV catheter use in the heparin group. The results were not combined for meta-analysis due to significant heterogeneity of the treatment effect (p<0.01). In addition, there were marked differences between the studies in terms of the methodological quality, the dose, the timing, the route of administration of heparin and the outcomes reported. From a limited number of studies, there were no significant differences between the heparin and the placebo/no treatment groups in the risks of infiltration, phlebitis and intracranial hemorrhage.

IMPLICATIONS FOR PRACTICE

The effect of heparin on the duration of peripheral intravenous catheter use varied across the studies. Because of clinical heterogeneity and heterogeneity in treatment effect, recommendations for heparin use in neonates with PIV catheters cannot be made.

IMPLICATIONS FOR RESEARCH

There are insufficient data concerning the effect of heparin for prolonging PIV catheter use in neonates. Further research on the effectiveness, the optimal dose, and the safety of heparin is required.

Saline for peripheral intravenous locks in neonates: evaluating a change in practice

PURPOSE

To evaluate the efficacy of saline versus 10 units/ml heparin for peripheral i.v. flushes in neonates.

DESIGN

A nonexperimental group design was used to compare the longevity of heparin and saline i.v. locks. A research utilization method was chosen to increase the study power while simultaneously implementing a practice change and evaluating the outcomes. Power analysis showed that a sample size of approximately 120 per group was needed to decrease the risk of beta error to 0.1.

SAMPLE

Subjects included neonates in the Special Care Nurseries at a Level III large midwestern university teaching hospital. Data were collected from a convenience sample of 123 neonates receiving 10 units/ml heparin flush into a peripheral i.v. Practice was then changed to preservative-free normal saline, and data collection continued for 117 neonates.

MAIN OUTCOME VARIABLE

I.v. catheter longevity.

RESULTS

There was no significant statistical difference in i.v. catheter longevity between i.v. locks flushed with 10 units/ml heparin and those flushed with normal saline. Patient weight accounted for a significant proportion of the variance in i.v. catheter life.