White, Mary L., Jamie Crawley, Linda A. Lewandowski, and Elizabeth A Rennie
While the use of saline instead of heparin as a flush for capped IV lines has been widely accepted in adult patients, its use in smaller lumen pediatric lines has remained controversial. Reasons for using saline include decreased pain, decreased nursing time, reduced side effects, cultural considerations, and cost-effectiveness. Concerns about using saline focused on fears of clotting and losing pediatric lines. The purpose of this study was to compare the effectiveness of heparin and normal saline to flush capped pediatric peripheral (CPP) IV lines at Children's Hospital of Michigan (CHM). The randomly-assigned sample included 62 in-patient pediatric patients (32 Heparin, 30 Saline) on three units with 24, 22 or 20 gauge IV catheters. Inclusion criteria for the study included: children between the ages of 4 weeks and 17 years who had a CPP IV or an IV that had the potential to be converted to a CPP IV. HIPPA, parental informed consent and child assent (if age-appropriate) were obtained by IV Team members. Patients were randomly assigned to either the Heparin or Saline flush group. Study nurses assessed the capped peripheral IV line every 6 to 8 hours for redness, swelling, clotting, bruising, leakage, and patient pain. Data were recorded for as long as the line remained patent or until it was discontinued. Chi-square analyses revealed no significant differences between Heparin and Saline groups on any study variables including catheter gauge. Post–implementation follow-up of 30 additional patients (24-gauge [n = 14], 22 gauge [n = 13], 20-gauge [n = 3]) found no problems or line loss, even in the smaller catheters, thus confirming study results. These results, combined with corroborating evidence from other studies, provide evidence for using saline instead of heparin when flushing CPP IV lines, including the use of saline when flushing smaller lumen catheters.