Benefit and risk of heparin for maintaining peripheral venous catheters in neonates: a placebo-controlled trial. A randomized trial of heparin and saline for maintaining intravenous locks in neonates. Patency of 24-gauge peripheral intermittent infusion devices: a comparison of heparin and saline flush solutions. Comparison of normal saline and heparinized saline for patency of IV locks in neonates. The use of heparin and normal saline flushes in neonatal intravenous catheters. Efficacy of heparin in peripheral venous infusion in neonates. The efficacy of heparin in maintaining peripheral infusions in neonates. Heparin vs saline for intermittent intravenous device maintenance in neonates.
Heparin addition to infusion fluids is used to prolong catheter patency in newborns. Heparin may also induce adverse effects such as bleeding complications and immune-mediated heparin-induced thrombocytopenia (HIT). One objective was peripheral venous catheter patency with heparinization of continuous infusions (0.5 IU/mL). Secondary objectives were incidences of bleeding, clinically manifest HIT, HIT antibodies, and catheter-related complications.
                Inclusion criteria were anticipated need for intravenous peripheral infusion (>or=5 days for HIT-related endpoints) and postnatal age <28 days at study entry. Exclusion criteria were bodyweight <1000 g, congenital malformation, need for therapeutic anticoagulation or mechanical ventilation, and severe bleeding. HIT antibodies were assessed by enzyme-linked immunosorbent assay.
                A total of 145 infants received heparin, and 151 infants received saline. Patient characteristics, number of additional drugs, duration of treatment, and location and size of catheters did not differ. Patency of catheters was 7.4 hours longer in the heparin group (33.8 hours vs 26.4 hours, P<.0001), but the total numbers of catheters did not differ (565 vs 692, P=.3). No infant developed HIT antibodies. Incidences of bleeding complications and thrombocytopenia were comparable between groups.
                Balancing the benefits against the risks of heparin addition and the rare complication of HIT, we will not use 0.5 IU/mL heparin addition to parenteral fluids. To determine the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (i.v.) locks and the incidence of i.v. infiltration in neonates.
                Randomized double-blind experiment.
                Tertiary-care nursery.
                Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units.
                Total hours from the time the i.v. was inserted to the time the i.v. was removed; hours from the time the i.v. was first flushed to the time the i.v. was removed; number of i.vs. removed because of infiltration.
                No statistical or clinical differences between the three groups for duration of i.v. nor for incidence of complications.
                The use of heparin in i.v. lock flush solution did not affect the duration of i.v. locks nor the incidence of infiltration in neonates. The purpose of this study was to compare the effectiveness of heparin and normal saline flush solutions in maintaining the patency of 24-gauge peripheral intermittent infusion devices (PIIDs). A prospective, non-randomized, sequential, blinded study design was conducted on a pediatric and a neonatal intensive care unit. The sample consisted of 134 catheters in 61 patients. Heparin and saline flush groups were similar for age, PIID placement site, irritating substances infused, and initial IV function. The median duration of catheters flushed with heparin was 42 hours and with saline was 35.3 hours. Kaplan-Meier Survival Analysis indicated that the duration of catheters flushed with heparin was significantly longer than those flushed with saline (p = .02). More catheters flushed with saline were removed because of problems (p = .027). Results of this study suggest that heparin is more effective than saline in maintaining the patency of small, 24-gauge catheters. In this randomized double-blind experiment of 49 neonatal intensive care unit patients, probable time to catheter failure was significantly longer (p =.0358) for catheters flushed with heparinized saline (median = 127) compared with those flushed with normal saline (median = 39). This is in contrast to the nonsignificant difference (p =.841) in mean scores for six heparin-flushed catheters (M = 41.5 hours, SD = 44.0) compared with 18 saline-flushed catheters (M = 30.4 hours, SD = 20.8) discontinued for reasons other than completion of treatment. We concluded that survival time analysis is necessary when evaluating results of time-dependent studies in which the end point may not be elective.
                Copyright 2002 by W.B. Saunders Company To compare the effects of heparin versus normal saline flush solutions on the duration of patency of peripheral IV catheters in neonates.
                A quasi experimental design compared the outcomes in 87 infants who were 32 weeks or greater gestation at birth. Thirty-three received heparin and 54 received normal saline.
                There were 159 starts among the subjects. No statistically significant difference in duration of patency between the groups was found. The duration was significantly longer for term than preterm infants and for insertion in scalp, arm, or hand than for leg or foot.
                Gestational age and site of insertion were the only predictor variables related to duration of patency for IV catheters. To determine the efficacy of continuous, low-dose heparin infusion in prolonging peripheral venous catheter patency in neonates.
                Randomized, prospective study.
                Level III neonatal intensive-care unit.
                113 neonates requiring i.v. therapy.
                The neonates were randomly assigned to heparin (n = 63). The heparin group received 1/2 unit of heparin per milliliter of continuous intravenous infusate or intermittent heparin flush.
                Low-dose heparin infusion does not make a difference in the duration of peripheral venous catheter patency. The incidence of catheter-related complications in the heparin group is the same as for those receiving no heparin.
                The mean duration of catheter patency was 62.75 hours in the heparin group and 27.3 hours in the no-heparin group (p = .0001). The occurrence of infection, bleeding, and extravasation injury was zero in the sample studied. The incidence of phlebitis was 18 cases in 132 (13%) in the heparin group and 13 cases in 122 (10%) in the no-heparin group. According to chi-square analysis, the difference between groups was not statistically significant (p greater than .05).
                Low-dose heparin infusion in peripheral venous catheters in neonates increased the duration of intravenous catheter patency (p = .0001) without increased risks of bleeding, infection, phlebitis, or extravasation injury. The study set out to determine the survival times of peripheral total parenteral nutrition (TPN) infusion sites in neonates using a prospective, single blind, randomised trial design. The effects of various concentrations of co-administered heparin was measured using survival analysis, and of other continuous variables using multivariate analysis, against a non-heparinized control group. The study was conducted in special care baby unit located within a specialist maternity hospital in London, United Kingdom. Heparin at 0.1, 0.25, 0.5 and 1 IU/ml was added to TPN infusions delivered through peripheral veins and the survival times of the infusions determined. For infusion sites receiving heparinized fluids, the relative risk of failure decreased and the median survival time increased as the heparin concentration increased, with a maximal effect at a heparin concentration of 0.5 IU/ml (P < 0.001). Multivariate analysis using the Cox proportional hazard model confirmed the efficacy of heparin and highlighted a history of infusion therapy and the co-administration of gentamicin (from a range of drugs analysed) as being risk factors associated with infusion site failure.
                Intravenous infusion survival time can be prolonged using heparin additive at an optimal concentration of 0.5 IU/ml. This should also be of additional interest to paediatricians as heparin is an ubiquitous drug on neonatal units and its clinical use needs to be rationalised. The purpose of this study was to determine whether normal saline (NS) is as effective as 10 units heparin/ml saline (HS) in maintaining patency of intermittent intravenous devices (i.v. locks) in neonates. We conducted a prospective, double-blind, randomized study of 118 24-gauge catheters used exclusively as i.v. locks and removed consequent to catheter failure. Subjects were infants, including premature infants, less than one month of age, admitted to a Level II NICU. Catheters were observed for length of patency as well as incidence of phlebitis, occlusion, infiltration, and leaking. There was no statistically significant difference in average duration of patency between NS-flushed catheters and HS-flushed catheters. Phlebitis, occlusion, infiltration, and leaking occurred with equal frequency for both solutions.
There are insufficient data concerning the effect of heparin for prolonging PIV catheter use in neonates. Recommendations for heparin use in neonates with PIV catheters cannot be made. Further research on the effectiveness, the optimal dose, and the safety of heparin is required.