Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials

Abstract

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.

Figures

Figure 1

Relative risks (95% confidence intervals) for catheter clot formation in and loss of patency of peripheral venous and arterial catheters according to treatment with or without heparin. Last two columns are numbers of catheters with clots/total number of catheters

Figure 2

Relative risks (95% confidence intervals) for failure of infusion in peripheral venous catheters according to treatment with or without heparin. Last two columns are numbers of catheters with failure of infusion/total number of catheters

Figure 3

Relative risks (95% confidence intervals) of phlebitis from peripheral venous catheters according to treatment with or without heparin. Last two columns are numbers of catheters associated with phlebitis/total number of catheters