Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials

BMJ 1998;316:969-975 ( 28 March )

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Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials

Adrienne G Randolph, clinical fellow, ^a Deborah J Cook, associate professor, ^b Calle A Gonzales, clinical fellow, ^c Maureen Andrew, associate professor. ^d

^a Departments of Pediatrics and Anesthesia, Children's Hospital and Harvard Medical School, Multidisciplinary Intensive Care Unit, Farley 517, 300 Longwood Avenue, Boston, MA 02115, USA, ^b Departments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, ^c Department of Pediatrics (Division of Pediatric Critical Care), University of California, San Francisco, California, United States, ^d Department of Paediatrics (Division of Paediatric Haematology), McMaster University, Hamilton, Ontario

Correspondence to: Dr Randolph randolph_a{at}al.tch.harvard.edu

Objective: To evaluate the effect of heparin on duration of catheter patency and on prevention of complications associatedwith use of peripheral venous and arterial catheters.
Design: Critical appraisal and meta-analysis of 26 randomised controlled trials that evaluated infusion of heparinintermittently or continuously. Thirteen trials of peripheralvenous catheters and two of peripheral arterial catheters metcriteria for inclusion.
Main outcome measures: Data on the populations, interventions, outcomes, and methodological quality.
Results: For peripheral venous catheters locked between use flushing with 10 U/ml of heparin instead of normal salinedid not reduce the incidence of catheter clotting and phlebitisor improve catheter patency. When heparin was given as a continuousinfusion at 1 U/ml the risk of phlebitis decreased (relative risk0.55; 95% confidence interval 0.39 to 0.77), the duration of patencyincreased, and infusion failure was reduced (0.88; 0.72 to 1.07).Heparin significantly prolonged duration of patency of radialartery catheters and decreased the risk of clot formation (0.51;0.42 to 0.61).
Conclusions: Use of intermittent heparin flushes at doses of 10 U/ml in peripheral venous catheters locked betweenuse had no benefit over normal saline flush. Infusion of low doseheparin through a peripheral arterial catheter prolonged the durationof patency but further study is needed to establish its benefitfor peripheral venous catheters.

Key messages

Despite almost universal use, agreement has not been reached on the need to administer heparin through peripheral intravascular catheters
The results of 13 trials on peripheral venous catheters and two trials on peripheral arterial catheters were critically appraised to clarify what evidence supports the use of heparin
Flushing peripheral venous catheters locked between use with heparinised saline at 10 U/ml is no more beneficial than flushing with normal saline
Heparin significantly prolongs the duration of peripheral arterial catheter patency and decreases the risk of clot formation
In peripheral venous catheters heparin added to the infusion at 1 U/ml decreases phlebitis and may prolong duration of catheter patency and decrease infusion failure

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