title: Low-dose heparin use and the patency of peripheral IV catheters in children: a systematic review.
abstract: OBJECTIVE
  To assess evidence from randomized controlled trials (RCTs) on the efficacy of low-dose heparin for prolonging patency of peripheral intravenous (PIV) catheters in the pediatric population.
  
  
  METHODS
  We searched Medline, Embase, CINAHL, and Cochrane Central Register of Controlled Trials to identify studies up to June 6, 2012. Additional citations were retrieved from the bibliography of selected articles. The eligible studies were RCTs of low-dose heparin used in PIV catheters as compared with control and measured any one of the following outcomes: duration of catheter patency, infusion failure rates, or phlebitis. Data were extracted by 1 reviewer by using a standardized form and checked for accuracy by a second reviewer. Discrepancies were resolved by consensus.
  
  
  RESULTS
  Thirteen RCTs were identified (3 RCTs of continuous infusion and 10 RCTs of intermittent flush). Catheters using heparin had longer patency (mean difference [95% confidence interval]: 26.51 hours [2.37 to 50.65], P < .001, for the infusion studies and 2.82 hours [-0.04 to 5.67], P = .05, for intermittent flush studies). Heparin usage also resulted in a lower rate of infusion failure (rate ratio [95% confidence interval]: 0.78 [0.62 to 0.99], P = .04, for the infusion studies and 0.88 [0.72 to 1.09], P = .25, for intermittent flush studies). Lower phlebitis rates were also observed with heparin usage; however, the results did not reach significance. There was no increase in heparin-related side effects noted.
  
  
  CONCLUSIONS
  Low-dose heparin as continuous infusion in PIV catheters resulted in clinically significant benefits in terms of catheter patency and fewer episodes of infusion failures. Heparin's use in intermittent flush solutions showed minimal benefits.
authors: Department of Pediatrics, University of Alberta, Edmonton, Canada. manojk@ualberta.ca
authors: Manoj
authors: M
authors: Kumar
authors: Ben
authors: B
authors: Vandermeer
authors: Dirk
authors: D
authors: Bassler
authors: Nadia
authors: N
authors: Mansoor
mesh_terms: D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D002648:Child; D004334:Drug Administration Schedule; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D014654:Vascular Patency / Q000187:drug effects* / Q000502:physiology
chemical_list: D006493:Heparin