BMJ 1998;316:969-975 ( 28 March )

Papers

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 associated with use of peripheral venous and arterial catheters.
Design: Critical appraisal and meta-analysis of 26 randomised controlled trials that evaluated infusion of heparin intermittently or continuously. Thirteen trials of peripheral venous catheters and two of peripheral arterial catheters met criteria 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 saline did not reduce the incidence of catheter clotting and phlebitis or improve catheter patency. When heparin was given as a continuous infusion at 1 U/ml the risk of phlebitis decreased (relative risk 0.55; 95% confidence interval 0.39 to 0.77), the duration of patency increased, and infusion failure was reduced (0.88; 0.72 to 1.07). Heparin significantly prolonged duration of patency of radial artery 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 between use had no benefit over normal saline flush. Infusion of low dose heparin through a peripheral arterial catheter prolonged the duration of patency but further study is needed to establish its benefit for 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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