Avoiding heparinization of arterial line and maintaining acceptable arterial waveform after cardiac surgery: A randomized clinical trial

Abstract

Background:Invasive and continuous blood pressure (BP) monitoring is crucial after cardiac surgery. Accuracy of BP measurement mostly depends on patency of arterial catheter and acceptable waveform. Heparinized saline flush usually used for this purpose may be accompanied by potential heparin adverse effects.Objectives:The aim of this study was to compare heparinized and non-heparinized saline flush to maintain acceptable arterial waveform after cardiac surgery.Materials and Methods:In a double blind randomized trial study, 100 patients undergoing elective cardiac surgery were randomized to using heparinized (n = 50) or non-heparinized (normal) saline flush (n = 50) to maintain patency of arterial catheter after operation. Indwelling arterial catheters were checked daily for acceptable arterial waveform for three days as primary outcome measures.Results:Frequency of acceptable arterial waveform ranged from 66% to 80%, in first, second and third postoperative days. There were no statistically significant differences between heparinized and non-heparinized saline groups regarding acceptable arterial waveforms in all the three postoperative days (all P values > 0.05).Conclusions:Using non-heparinized normal saline is suitable to maintain acceptable arterial waveform for short-term (three days) after adult cardiac surgery considering potential adverse effects of heparin.

A comparison of heparinised and non-heparinised normal saline solutions for maintaining the patency of arterial pressure measurement cannulae after heart surgery

“…Routine arterial cannula maintenance includes regular flushing with heparin solution (HS, heparin plus 0.9% sodium chloride) to prevent cannula occlusion [4]. Other cannula maintenance procedures include the use of infusions under positive pressure to prevent retrograde blood flow [4–6]. Heparin is a powerful drug in terms of its ability to prevent clots from forming in the cannula, but its use is not without risk of bleeding, allergic reactions and low platelet counts [7].…”

Heparinized Saline Solution vs. Saline Solution (0.9% Sodium Chloride) for the Maintenance of Dorsal Pedal Arterial Catheter Patency in Dogs Undergoing General Anesthesia: A Pilot Study

“…On the other hand, once the time frame exceeds 48 h of arterial catheter placement, HS has a significant advantage with longer arterial catheter patency compared to SS ( 23 ). Alizadehasl showed that SS was as effective as HS at maintaining arterial catheter patency for 72–96 h ( 3 ). Moreover, it is not just arterial catheter patency that has been examined, a systematic review and meta-analysis reported that HS is slightly better than SS at maintaining the central venous catheter patency within a short-term period (<30 days), whereas there was not a significant difference between HS and SS in catheter patency in a long-term period (> 30 days) ( 24 ), although the intended use, the duration of catheter placement, and management method between the arterial catheter and the central venous catheter are different.…”

“…To the best of our knowledge, there have been no reports of complications in dogs given a continuous HS infusion during direct arterial blood pressure measurements at this stage, but the use of heparin in dogs is not risk free. Furthermore, in humans, it has been reported that SS provides acceptable direct arterial pressure waveform and is a cost-effective practice in the Intensive Care Unit (2,3,10,11).…”

Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19

“…However,heparin increases clotting times and may result in fatal hemorrhages when doses are too high [50]. Frequent heparin flushing also affects the result of coagulation tests and disturbs the monitoring of heparin dosage [51]. Therefore, this consensus recommends avoiding heparin flush during vascular access placement for severe COVID-19 patients with coagulation dysfunction.…”