The efficacy of heparin in maintaining peripheral infusions in neonates.
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.


CONCLUSIONS
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.
Moclair
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A
Regional Pharmacy Offices, Chelsea and Westminister Hospital, London, United Kingdom.
Bates
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I
D001780:Blood Coagulation Tests; D002408:Catheters, Indwelling; D004305:Dose-Response Relationship, Drug; D004868:Equipment Failure; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D015993:Life Tables; D008297:Male; D010289:Parenteral Nutrition, Total / Q000295:instrumentation*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
D006493:Heparin