Heparin verses Normal Saline Flushes to Maintain Venous Access

Abstract

In recent years, medical experts have expressed a growing concern for patient safety regarding the use of heparin flushes to maintain patency of venous catheters. A systematic review has concluded that there is insufficient evidence to conclude that flushing catheters with heparin is more effective in preventing blood from clotting in the lines than flushing with a normal saline solution. This evidence-based paper will identify the effect of each solution on IV lines, the preferred solution for patient safety and how to implement the preferred solution into daily care to promote the best client outcome.

Heparin verses Normal Saline Flushes to Maintain Venous Access

During my clinical rotations, I have observed catheter patency checks being performed with a normal saline injection prior to each administration of intravenous medications. I often wondered how this nursing intervention was established.
Heparin flushes have been the commonly used solution to decrease occlusions for patients with intermittently used central venous catheters or intravenous catheters; until recently when medical experts completed a review of the associated risks with the use of heparin (Lewis, Dirksen, Heitkemper, Bucher, et al & Camera, 2011). Medical experts began to examine other interventions to maintain patency such as a normal saline flush.
Through research and collection of data regarding catheter patency, catheter-related bloodstream infections and heparin-induced thrombocytopenia, it was determined that there is insufficient evidence on the effectiveness or necessity of flushing catheters with heparin (Mitchell, Anderson, Williams & Umscheid, 2009). It was concluded that flushing with a normal saline solution is a safe and effective alternative to heparin (Cook, Bellini & Cusson, 2011). Currently at St. Joe’s Hospital, I observe the nurses checking catheter patency through the administration of normal saline prior to medication administration. Staff advised me that this has become normal practice after they received a heparin education class and a policy change. However, I can understand how there could be some barrier to implement this best practice. Since there is currently no conclusive evidence that heparin is effective or ineffective in catheter patency, some senior nurses who work in smaller or rural hospitals could possibly find the switch to saline a bit more challenging since prior education has taught them to use heparin. However, with sufficient heparin education as well as administration implementation of best practice through a policy change, this barrier can be efficiently resolved. I am currently pregnant and upon review of the evidence based practice research paper involving neonates I became increasingly alarmed. I remember watching a 60 minutes interview with Dennis Quaid regarding the massive overdose of heparin used to flush the IV lines of his two newborn twins. It is easy to think now how this situation could have been avoided if normal saline was used to flush the IV lines. There is no evidence that heparin flushes reduce catheter occlusions more effectively than saline. There is also no evidence heparin flushing reduces bloodstream infections. However, there is evidence that heparin flushes can lead to heparin-induced thrombocytopenia and there is evidence that heparin overdoses can be deadly. Therefore, I strongly support the evidence that a normal saline flush is the most safe and effective best practice giving clients the best outcome.

References
Cook, L., Bellini, S. & Cusson, R. (2011, June). Heparinized saline vs normal saline for maintenance of intravenous access in neonates: An evidence-based practice change. Advances in Neonatal Care, 11(3), 208-215.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., et al, L., & Camera, I. M. C. (2011). Medical-surgical nursing, assessment and management of clinical problems. (8th ed. ed.). St. Louis, Missouri: Mosby.

Mitchell, M., Anderson, B., Williams, K. & Umscheid, C. (2009, June 5). Heparin flushing and other interventions to maintain patency of central venous catheters: a systemic review. Journal of Advanced Nursing, 65(10), 2007-2021.