Is routine heparin lock placement beneficial in the evaluation and treatment of febrile children?
BACKGROUND
Nurses often use intravenous heparin locks (HL) with pediatric patients while obtaining laboratory studies to evaluate fever without a source. The purpose of the HL is to avoid an intramuscular injection if parenteral antibiotics are subsequently ordered. The objectives of this study were to determine if HL placement in patients undergoing laboratory evaluation for fever without a source (1) results in fewer injections and (2) is associated with increased use of antibiotics.


METHODS
A retrospective chart review of ED patients aged 3 to 36 months was performed. Patients included in the review had fever with no identified source of infection, and a complete blood cell count and/or blood culture had been ordered. For analysis, patients who received an HL were compared with patients who did not receive an HL.


RESULTS
A total of 439 patients had laboratory studies for fever without a source, with 345 (79%) in the HL group. No statistically significant differences were found in antibiotic administration, number of needle sticks, age, temperature, or white blood cell count between the groups.


CONCLUSIONS
The use of an HL in young febrile ED patients did not change the total number of needle sticks or the likelihood of antibiotic administration.
Mahabee-Gittens
E M
EM
Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229-2899, USA. maham0@chmcc.org
Grupp-Phelan
J
J
Luria
J W
JW
Gonzalez del Rey
J A
JA
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D001800:Blood Specimen Collection / Q000379:methods* / Q000592:standards*; D002406:Catheterization, Peripheral / Q000592:standards*; D002408:Catheters, Indwelling / Q000592:standards*; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D016529:Emergency Nursing; D004638:Emergency Treatment / Q000379:methods* / Q000451:nursing / Q000592:standards*; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000382:microbiology*; D006493:Heparin; D006801:Humans; D007223:Infant; D018579:Patient Selection; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006493:Heparin