Low-dose heparin use and the patency of peripheral IV catheters in children: a systematic review
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Published on: July 13, 2019
Manoj Kumar1, Ben Vandermeer, Dirk Bassler
1Department of Pediatrics, University of Alberta, Edmonton, Canada. manojk@ualberta.ca
Insights
Low-dose heparin in pediatric peripheral intravenous catheters significantly improves catheter patency and reduces infusion failures when used as a continuous infusion. Intermittent heparin flushes offer minimal benefits.
Area of Science:
- Pediatric critical care medicine
- Vascular access device management
- Pharmacology
Background:
- Peripheral intravenous (PIV) catheters are crucial for medication delivery in pediatric patients.
- Maintaining PIV catheter patency is essential to avoid repeated venipunctures and associated complications.
- Limited evidence exists on the efficacy of low-dose heparin for PIV catheter patency in children.
Purpose of the Study:
- To evaluate the effectiveness of low-dose heparin in extending the functional lifespan of PIV catheters in pediatric patients.
- To synthesize findings from randomized controlled trials (RCTs) on heparin's impact on PIV patency, infusion failures, and phlebitis.
Main Methods:
- Comprehensive literature search of major databases (Medline, Embase, CINAHL, Cochrane) up to June 2012.
- Inclusion of RCTs comparing low-dose heparin with control for PIV catheters in pediatric populations.
- Extraction and analysis of data on catheter patency duration, infusion failure rates, and phlebitis incidence.
Main Results:
- Continuous infusion of low-dose heparin significantly prolonged PIV catheter patency (mean difference: 26.51 hours; P < .001).
- Continuous heparin infusion also reduced infusion failure rates (rate ratio: 0.78; P = .04).
- Intermittent heparin flushes showed a trend towards longer patency (P = .05) but minimal impact on infusion failures (P = .25); phlebitis rates were not significantly affected by heparin.
Conclusions:
- Continuous infusion of low-dose heparin in pediatric PIV catheters provides clinically significant improvements in catheter longevity and reduces infusion failures.
- The benefits of heparin for intermittent flushing of PIV catheters are minimal.
- No increased heparin-related adverse events were observed in the included studies.
Objective:
To assess evidence from randomized controlled trials (RCTs) on the efficacy of low-dose heparin for prolonging patency of peripheral intravenous (PIV) catheters in the pediatric population.
Methods:
We searched Medline, Embase, CINAHL, and Cochrane Central Register of Controlled Trials to identify studies up to June 6, 2012. Additional citations were retrieved from the bibliography of selected articles. The eligible studies were RCTs of low-dose heparin used in PIV catheters as compared with control and measured any one of the following outcomes: duration of catheter patency, infusion failure rates, or phlebitis. Data were extracted by 1 reviewer by using a standardized form and checked for accuracy by a second reviewer. Discrepancies were resolved by consensus.
Results:
Thirteen RCTs were identified (3 RCTs of continuous infusion and 10 RCTs of intermittent flush). Catheters using heparin had longer patency (mean difference [95% confidence interval]: 26.51 hours [2.37 to 50.65], P < .001, for the infusion studies and 2.82 hours [-0.04 to 5.67], P = .05, for intermittent flush studies). Heparin usage also resulted in a lower rate of infusion failure (rate ratio [95% confidence interval]: 0.78 [0.62 to 0.99], P = .04, for the infusion studies and 0.88 [0.72 to 1.09], P = .25, for intermittent flush studies). Lower phlebitis rates were also observed with heparin usage; however, the results did not reach significance. There was no increase in heparin-related side effects noted.
Conclusions:
Low-dose heparin as continuous infusion in PIV catheters resulted in clinically significant benefits in terms of catheter patency and fewer episodes of infusion failures. Heparin's use in intermittent flush solutions showed minimal benefits.
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