Arterial catheter audit

C Doherty, J Rigg, J BoultonCritical Care Unit, Stockport NHS Foundation Trust

28th November 2011

Evidence

Ashton J et al(2) RCT 32 patients. NS versus Hep 10u/ml no sig difference in patency or phlebitis. More bleeding with hep

Niesen KM et al(3) RCT 73 patients. NS versus Hep 10u/ml. No sig difference

EvidenceClifton GD et al(4) DB RCT 30 patients saline versus heparin4u/ml, flow 3ml/hr. Sig difference in catheter survival rates withhepsal resulting in longer patency

Whitta RKS et al(5) RCT 65 patients. Saline versus hep 1u/ml, flow3ml/hr.No difference in life span or function

American association of Critical care nurses(6)RCT hepversus saline.5139 patients. Sig difference. Hepsal betterPatency, longer lifespan

Regional practice

UHSM Hepsal

Blackpool Hepsal

Hope Hepsal

Oldham Hepsal

Tameside* Hepsal

Blackburn Saline

Bolton Saline

Burnley* Saline

Bury* Saline

Lancaster Saline

Macclesfield Saline

MRI Saline

NMGH Saline

Preston Saline

Rochdale Saline

Stockport Saline

Wigan Saline

Audit design• Inclusion criteria – all arterial

catheters inserted at Stepping Hill Hospital managed up to removal by critical care unit

• Set standard for thrombosis rate <= 5%

• Measure thrombosis rate using saline as flush solution

• If thrombosis rate exceeds 5%, re-introduce heparinised saline as flush solution and undertake audit again

• Compare thrombosis rates using different solutions

Audit progress

• Audit ran for two consecutive six week periods between October 1st and December 31st 2010

• 128/130 potential patients reviewed

• 157 arterial catheters were valid for analysis

Reason for removal

Reason for removal Number

Dislodged 5

Not required 98

Suspected infection 8

Thrombosed 45

Vascular insufficiency 1

Total 157

Demographics

SalineHeparinised

saline p value Chi2

test

Number 77 80

Average age 60.6 57.3

Ratio Male to Female 0.61 0.62

Average APACHE II score 20.0 21.1

Average predicted mortality rate 0.34 0.37

Ratio planned admissions 0.40 0.21 0.009

Ratio patients receiving intensive care 0.43 0.64 0.008

Site of insertion

Right Left

Brachial 5 7

Radial 58 84

Femoral 2 0

Dorsalis pedis 1 0

SalineHeparinised

saline

Ratio radial 0.88 0.94

Number of arterial

catheters

Number of patients

1 100

2 36

3 9

4 12

Total 157

Main results

p value Chi2 test = 0.000

Lifespan of arterial catheters

p value Mann Whitney U test = 0.000

Consequences

Conclusions

• Heparinised saline is more effective than saline in reducing thrombosis in arterial catheters

• Use of saline as flush solution led to examples of poor practice

References1.Rapid Response Report NPSA/2008/RRR002. Natioanl Patient Safety Agency. April20082.Ashton J et al. Effects of heparin versus saline solution on intermittentinfusion device irrigation. Heart Lung. 1990;19:608-6123.Niesen KM et al. The Effects of heparin versus normal saline for maintainingperipheral intravenous locks in pregnant women. J Obstet Gynecol NeonatalNurs. 2003;32:503-5084.Clifton GD et al. Compariosn of normal saline and heparin solutions formaintenance of arterial catheter patency. Heart Lung. 1991;20:115-1185.Whitta RKS et al.Comparison of normal or heparinisedsaline on function of arterial lines. Crit Care Resusc. 2006;8:205-2086. American association of Critical care nurses. Evaluation of the effects ofheparinised and nonheparinised flush solutions on the patency of arterialpressure monitioring lines: the AACN Thunder Project. Am J Crit Care.1993;2:3-15.