Saline and Heparinised Flush in Maintaining Patency of Arterial Catheters in Adult Patients—A Systematic Review

This paper compares the effectiveness of normal saline and heparinised saline as a flushing solution in maintaining patency of arterial catheters. Use of heparin as a flushing solution in maintaining patency of intraarterial catheters has been a recognized practice. Due to its anticoagulation properties, heparin can cause side effects like heparin-induced thrombocytopenia in hypersensitive patients. The alternative, normal saline solution increases the accuracy of patients’ coagulation status and enhances safer clinical practice. A systematic search was conducted at Cochrane Library, Medline, CINAHL, OVID and Joanna Briggs Institute. Review period covered from 1990 to 2011. Methodological validity of included studies was evaluated using SIGN grading checklists from Scottish Intercollegiate Guidelines Network. There is inconsistent evidence and sample sizes were too small to allow statistical significance to be achieved. Meta-analysis was performed for 2 studies; results revealed that heparinised saline offers no added advantage over normal saline. There is insufficient evidence to support the use of heparinised saline for flushing arterial catheters. A rigorous research design is needed to determine variables known to influence patency of arterial catheters. Sound clinical judgement must be exercised in situations that require the need of heparinised saline.