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Heparin versus normal saline for patency of arterial lines.
[heparin-induced thrombocytopenia]
For
most
patients
who
require
intensive
care
,
the
success
of
clinical
decision
making
and
interventions
is
dependent
on
the
accuracy
of
different
physiological
variables
measured
or
obtained
from
samples
using
an
arterial
catheter
.
Maintaining
the
patency
of
these
catheters
is
therefore
essential
for
obtaining
accurate
measures
,
minimizing
patient
discomfort
and
reducing
expenses
incurred
when
an
occluded
catheter
requires
replacement
.
Uncertainty
exists
amongst
clinicians
as
to
best
practice
surrounding
the
contents
of
the
arterial
catheter
flush
solution
(
heparin
or
saline
)
.
The
use
of
heparin
is
more
expensive
and
is
accompanied
by
significant
risks
such
as
haemorrhage
,
hypersensitivity
and
heparin-induced
thrombocytopenia
(
HIT
)
.
The
objective
of
this
review
was
to
evaluate
whether
normal
saline
is
as
efficacious
and
safe
as
heparin
in
maintaining
the
patency
of
arterial
intravascular
catheters
in
adult
patients
without
a
haematological
disorder
.
Randomized
clinical
trials
(
RCTs
)
were
identified
through
electronic
database
searches
:
Cochrane
Central
Register
of
Controlled
Trials
(
CENTRAL
)
2013
,
Issue
1
,
part
of
The
Cochrane
Library
;
MEDLINE
(
Ovid
,
1966
to
March
2013
)
;
EMBASE
(
Ovid
,
1988
to
March
2013
)
and
CINAHL
(
1988
to
March
2013
)
,
using
specific
strategies
as
advised
by
the
Cochrane
Anaesthesia
Group
search
specialist
.
We
contacted
trial
authors
to
ask
for
additional
information
as
needed
.
Randomized
controlled
trials
and
quasi-randomized
studies
irrespective
of
blinding
or
language
that
compared
an
arterial
catheter
flush
solution
comprising
any
dose
of
heparin
versus
an
infusion
of
normal
saline
only
.
Two
review
authors
independently
screened
for
methodological
quality
and
extracted
data
from
all
identified
studies
that
met
the
protocol
inclusion
criteria
.
A
total
of
seven
studies
(
606
participants
)
met
the
inclusion
criteria
and
measured
the
primary
outcome
of
interest
.
All
studies
were
at
unclear
to
high
risk
of
bias
.
Given
the
high
degree
of
clinical
and
statistical
heterogeneity
of
the
included
studies
,
no
meta
-analysis
was
completed
.
The
results
from
individual
studies
that
compared
heparin
at
a
dose
of
1
to
2
IU
/
mL
under
continuous
pressure
were
imprecise
and
do
not
provide
definitive
evidence
of
a
difference
.
The
observed
difference
with
a
dose
of
heparin
increased
to
4
IU
/
mL
came
from
only
one
study
of
30
participants
,
and
the
quality
of
the
reported
data
was
poor
.
Similarly
.
consistency
in
assessment
and
reporting
of
adverse
events
such
as
haematoma
,
insertion
site
infection
and
limb
ischaemia
was
poor
.
Further
research
with
well-defined
primary
and
secondary
outcome
measures
using
a
stratified
sampling
process
that
accommodates
for
the
different
heparin
doses
commonly
used
in
clinical
practice
is
needed
to
confirm
the
trends
seen
in
research
results
now
reported
in
the
literature
.
The
available
evidence
is
of
poor
quality
because
of
risk
of
bias
and
does
not
provide
sufficient
information
to
support
the
effects
of
adding
heparin
(
1
to
2
IU
/
mL
)
to
a
maintenance
solution
(
pressurized
to
deliver
3
mL
of
flush
solution
per
hour
)
of
0
.
9
%
normal
saline
in
maintaining
the
patency
and
functionality
of
arterial
catheters
.
Diseases
Validation
Diseases presenting
"further research"
symptom
22q11.2 deletion syndrome
achondroplasia
canavan disease
child syndrome
esophageal adenocarcinoma
harlequin ichthyosis
heparin-induced thrombocytopenia
inclusion body myositis
junctional epidermolysis bullosa
legionellosis
neuralgic amyotrophy
oculocutaneous albinism
phenylketonuria
waldenström macroglobulinemia
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