Effect of Adding Heparin in Very Low Concentration to the Infusate to Prolong the Patency of Umbilical Artery Catheters

Abstract

A randomized controlled study was done to determine whether the addition of heparin, in very low concentration (0.25 U/ml), to fluids administered through an umbilical artery catheter (UAC) would affect the duration of catheter patency. UAC occlusion occurred in 2 of 15 patients in the heparin group and in 11 of 15 patients in the control group (p = 0.001). Using life-table analysis, the functional life span of UAC was estimated. On day 8, 100% of UACs in heparin group and 9% of UACs in control group were patent (p < 0.05). Coagulation profile remained unaltered after addition of heparin compared with that before the start of the therapy. There was no difference in the incidence of subependymal intraventricular hemorrhage between the two groups. It is concluded that heparin in such low concentration is effective in prolonging duration of UAC patency without causing adverse effects.

Antithrombotic Therapy in Neonates and Children

“…337,338 Longer-term outcomes include death, 339 persistent renovascular hypertension, and lower-limb growth abnormalities. 340 Six RCTs addressed the use of low-dose heparin infusions in neonates with UACs, [341][342][343][344][345][346] which was the subject of a systematic review by Barrington. 347 Five studies compared the use of UFH in the UAC infusate with or without additional UFH in fl ush solutions vs no UFH, whereas one compared the use of UFH in the infusate vs UFH in the fl ush solution.…”

Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections

“…Category IA 6. Add low-doses of heparin (0.25-1.0 U/ml) to the fluid infused through umbilical arterial catheters [151][152][153]. Category IB 7.…”

Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates

“…There are several concerns associated with the addition of heparin to TPN fluid in neonates. These include an increase in the levels of unbound serum bilirubin (9,10) and free fatty acids (11)(12)(13), a reduction in platelet count (14)(15)(16) and an increase in the incidence of intraventricular haemorrhage (IVH) (3,15,(17)(18)(19).…”