Heparin Flushes Are Needed to Maintain Catheter Patency and Are Benign

We reported decades ago that the small amounts of heparin used in catheter flush solutions sometimes caused the full-blown HIT syndrome and more often promulgated the syndrome (Rice and Jackson, 1981; Rice et al., 1986, 1988), observations that have been verified by others (Doty et al., 1986). Even the small amounts of heparin that leaches from heparin-bonded central venous or pulmonary artery catheters has been reported to cause full-blown HIT (Laster and Silver, 1988). It is clear from a meta-analysis of randomized trials that there is no advantage to heparin flush over saline in maintaining patency of traditional "hep lock" peripheral venous catheters (Randolph et al., 1998). The data are scant with regard to other types of catheters (e.g., intra-arterial catheters, percutaneously inserted central catheters), but further exploration of risks/benefits are warranted. Clearly, it is important to eliminate all exposures to heparin that are unnecessary and also to eliminate heparin completely when HIT is suspected.

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