Linda Cook, DNP
Heparinized vs Normal Saline for Maintenance of IV Access: An Evidence-based Practice Change Initiative
Both heparinized saline (HS) and normal saline (NS) are used to flush IV access devices in neonates. At this time there is no convincing evidence that heparin is superior. Despite this lack of supporting evidence and in fact the existence of evidence suggesting that heparin poses significant safety risks to patients; heparin continues to be utilized in neonatal intensive care units (NICU). The purpose of this project was to design, implement, and evaluate an evidence-based practice change to improve patient safety. A comparative 2-prong descriptive design was utilized. Phase I of the project pertained to dwell time, hours of patency, etc. for IV access devices prior to and following the practice change from HS to NS flush. Phase II of the project compared staff knowledge scores before and after an educational offering surrounding the practice change. The setting was an 18 bed level III NICU located in the northeastern United States. A sample of 70 IV locks was included in the study; HS (n = 34) and NS (n = 36) respectively. NICU staff (n = 40) were recruited for the educational offering. Results included a statistically significant difference in IV catheter patency with NS flushed catheters lasting on average, 13 hours longer than HS flushed catheters (p <0.5). A statistically significant increase in mean scores was noted on the NICU staff posttest after the educational offering (p <0.5). There was a 20% increase in knowledge scores. The outcome from this project does support current studies with no difference in outcomes between HS and NS flush. Future research should examine the use of heparin in central lines in neonates.