Comparison of normal saline and heparinized solutions for the maintenance of arterial catheter pressure waves: a randomized pilot study
1Department of Emergency and Critical Care Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku,160-0023 Tokyo, Japan
Online publish date: 12 November 2020
Objectives: Heparinized continuous-flush solutions are used to maintain arterial catheter patency. We sought to compare the patency and pressure wave integrity of radial artery catheters maintained with heparinized or nonheparinized infusions. Methods: Patients in the emergency room and intensive care unit were consecutively enrolled and randomly assigned to receive a heparinized solution (heparin group, n = 18) or normal saline (NS group, n = 16). The functional duration of radial artery catheters, the differences between arterial catheter and brachial cuff blood pressures, and the pressure wave curve quality were determined. Results: The mean duration of functional cannulas did not differ significantly between the heparin and NS groups (120 ± 129 and 105 ± 82 hours, respectively, P = 0.689). There was no difference in blood pressure between arterial catheter measurements and brachial cuff measurements between the two groups (P = 0.607). Kaplan-Meier analysis showed that the incidence of pressure wave dampening did not differ between the groups (log-rank test, P = 0.896). Conclusions: No significant differences were found between heparinized and nonheparinized flush solutions for maintaining radial artery catheter patency and function.
Heparin; Intensive care; Emergency room; Catheter; Blood pressure monitoring
Yuri Ishii,Shiro Mishima,Kenta Aida,Jun Oda. Comparison of normal saline and heparinized solutions for the maintenance of arterial catheter pressure waves: a randomized pilot study. Signa Vitae. 2020.doi:10.22514/sv.2020.16.0088.
 McGee WT, Horswell JL, Calderon J, Janvier G, Van Severen T, Van den Berghe G, Kozikowski L. Validation of a continuous, arterial pressure-based cardiac output measurement: a multicenter, prospective clinical trial. Critical Care. 2007; 11: R105.
 Langwieser N, Prechtl L, Meidert AS, Hapfelmeier A, Bradaric C, Ibrahim T, et al. Radial artery applanation tonometry for continuous noninvasive arterial blood pressure monitoring in the cardiac intensive care unit. Clinical Research in Cardiology. 2015; 104, 518-524.
 Lapum JL. Patency of arterial catheters with heparinized solutions versus non-heparinized solutions: a review of the literature. Canadian Journal of Cardiovascular Nursing. 2006; 16: 64-70.
 Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthesia & Analgesia. 2009; 109: 1763-1781.
 Cormack GM, Kaufman LJ. Severe heparin-induced thrombocytopenia: when the obvious is not obvious, a case report. Journal of Medical Case Reports. 2007; 1: 13.
 Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recog-nition, treatment, and prevention: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004; 126: 311s-337s.
 Del Cotillo M, Grané N, Llavoré M, Quintana S. Heparinized solution vs. saline solution in the maintenance of arterial catheters: a double blind randomized clinical trial. Intensive Care Medicine. 2008; 34: 339-343.
 Robertson-Malt S, Malt GN, Farquhar V, Greer W. Heparin versus normal saline for patency of arterial lines. Cochrane Database of Systematic Reviews. 2014; 2014: CD007364.
 Alizadehasl A, Ziyaeifard M, Peighambari M, Azarfarin R, Golbargian G, Bakhshandeh H. Avoiding heparinization of arterial line and maintaining acceptable arterial waveform after cardiac surgery: a randomized clinical trial. Research in Cardiovascular Medicine. 2015; 4: e28086.
 Rijnders BJ, Van Wijngaerden E, Wilmer A, Peetermans WE. Use of full sterile barrier precautions during insertion of arterial catheters: a randomized trial, clinical infectious diseases. Clinical Infectious Diseases. 2003; 36: 743-748.
 Clifton GD, Branson P, Kelly HJ, Dotson LR, Record KE, Phillips BA, et al. Comparison of normal saline and heparin solutions for maintenance of arterial catheter patency. Heart & Lung. 1991; 20: 115-118.
 French Society of Anesthesia and Intensive Care. Arterial catheterization and invasive measurement of blood pressure in anesthesia and intensive care in adults. Annales Francaises d’Anesthesie et de Reanimation. 1995; 14: 444-453. (In French)
 Zevola DR, Dioso J, Moggio R. Comparison of heparinized and non-heparinized solutions for maintaining patency of arterial and pulmonary artery catheters. American Journal of Critical Care. 1997; 6: 52-55.
 Kordzadeh A, Austin T, Panayiotopoulos Y. Efficacy of normal saline in the maintenance of the arterial lines in comparison to heparin flush: a comprehensive review of the literature. Journal of Vascular Access. 2014; 15: 123-127.
 Branson PK, McCoy RA, Phillips BA, Clifton GD. Efficacy of 1.4 percent sodium citrate in maintaining arterial catheter patency in patients in a medical ICU. Chest. 1993; 103: 882-885.
 Butt W, Shann F, McDonnell G, Hudson I. Effect of heparin concentration and infusion rate on the patency of arterial catheters. Critical Care Medicine. 1987; 15: 230-232.
 Tuncali BE, Kuvaki B, Tuncali B, Capar E. A comparison of the efficacy of heparinized and nonheparinized solutions for maintenance of perioperative radial arterial catheter patency and subsequent occlusion. Anesthesia & Analgesia. 2005; 100: 1117-1121.
 Ling E, Warkentin TE. Intraoperative heparin flushes and subsequent acute heparin-induced thrombocytopenia. Anesthesiology. 1998; 89: 1567-1569.
 Heeger PS, Backstorm JT. Heparin flushes and thrombocytopenia. Annals of Internal Medicine. 1986; 105: 143-143.
Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.