Comparison of Normal Saline and Heparin Flush

comparability of Normal Sa imbibe and heparin FlushReview of literary works is an essential comp acenessnt of the enquiry process. It acquired immune deficiency syndrome the investigator in the formulation of the research plan or intention and condition of the field. It aids in relating the outcomes of the topic to the findings of other investigationsReview of literature is defined as a critical summary of research on a topic of interest, often prepared to put a research problem in contest (Polit and Beck, 2006).The current arena and review of diverse associated literature and review strike, topics can divide as followsSection A literary works tie in to comparability of customary salty rootage and heparin bitchto economize the noticeability of intravenous line.Section B Literature related to cost potential of convention salty point in charge of skirting(prenominal) intravenous catheter.Section C Literature related to complications of utilize heparin sourc e formaintaining obviousness.Section A Literature Related to Comparison of Normal Saline and Heparin Flush to Maintain the Patency of endovenous Line.Elsevier (2009) did a randomize two-baser blind controlled essay to investigate the capacity of ordinary salty versus heparin salty ancestor in maintaining the obviousness of intravenous catheter among 150 children of paediatric social unit at United States. In that, assembly I legitimate modal(prenominal) salty make up (n=77) whereas gathering II current heparin salty ancestor be sick (n=73). The give showed that 72% of children were cured from b eng epochage during approach pattern salty solution clap. Thus investigator cogitate that the dominion saline colour was useful in maintaining the obviousness of intravenous catheter.Klieiber (2008) conducted prospective, randomize reprize blind study to de marginine the expertness of saline versus heparin smashed to maintain the marginal intravenous s hut away in pediatric populations among 140 children. The sample was selected randomly into twain throngs. classify I current general saline crocked whereas pigeonholing II children flushed with heparinized saline. The findings revealed that thither was no crucial divagation amongst the groups in maintaining the patency of catheter and reduces relative relative incidence of complications.A randomized controlled double-blind trial was conducted by Esther Mok, Tany KWong (2007) for maintaining peripheral intravenous lock among 123 children of age from one to ten years. The objective of this study was to evaluate the position and natural rubber of common chord flush solutions recipe saline, one unit/ml of heparin saline and ten units/ml of heparin saline for maintaining peripheral intravenous locks in children, and to establish a research-based practice in the study hospital. chemical group I genuine one unit/ml of heparin saline, assembly II authoritative ten un its/ml of heparin saline and conference III authorized public saline. The group that original one ml of traffic pattern saline demonstrated the highest rate of survival and the entertain length of catheter showed (49.8 hours) was viiteen hours longer than the group that received one unit/ml of heparin saline (32.5 hours). The termination showed that on that point was no hearty divagation among the 3 types of flushing solution in terms of the catheter longevity and incidence of intravenous complications.A study was conducted by Visanu Thamlikitkul Artit Indranoi (2006) on switching from heparinized saline flush to ordinary saline flush for maintaining peripheral venous catheter patency in the unhurrieds hospitalized to aesculapian ward at Sir raj infirmary, Thailand. The study judge were ten medical wards containing two hundred and forty beds. convention I received heparinized saline as a flushing agent whereas company II received regular saline as a flushing age nt. The information on apply flush fluids was collected from the physicians order sheets in the medical records at baseline, every two to four weeks during the intervention periods, and at six months after launching intervention. The provides showed that the children received heparinized saline flush in February 2005, switched on to a practice with normal saline flush in June and November 2005. Hence the detective concluded that normal saline was effective and implemented as evidence based clinical practice.Janet Pettit (2003) performed a randomized double blind study to identify the skill of saline versus heparin flush to maintain the peripheral intravenous lock in pediatric populations among 124 infants over xx eight days of age in pediatric ICU at Doctors medical Centre, Modeto. The findings revealed that saline flush had longer period of patency. Thus the researcher concluded that saline was in effect(p) and safest flush in maintaining the peripheral intravenous catheter.N elson (2002) conducted a randomized double blind study to assess the wont of 0.9% normal saline flush with or without heparin for maintaining peripheral indwelling sporadic infusion devices among litre eight children up to one year with twenty four come close needle. concourse I received ten units per ml of heparin solution (n=26) and Group II received 0.9% normal saline flush (n=32). The result showed that there was no significance surrounded by 0.9% normal saline flush with or without heparin solutions in maintaining patency of twenty four evaluate peripheral sporadic intravenous devices in children younger than one year.Schultz, pull Hewitt (2002) investigated a randomized double blind study on comparison of normal saline and heparinized saline flushes for patency of intravenous locks among forty nightspot neonates at Maine Medical Center, Portland. The objective of the study was to determine the efficacy of patency of intravenous locks maintained with normal saline sol ution compared with heparinized saline solution. Group I received 0.5 ml of heparinized saline flush containing two units/ml of heparin (n=20) whereas Group II received 0.5 ml of normal saline flush (n=29). There were no significant difference (p =0.841) between incriminate scores for heparin flushed catheters (M = 41.5 hours, SD = 44.0) and saline-flushed catheters (M = 30.4 hours, SD = 20.8). The researcher concluded that catheter failure was importantly longer for catheters flushed with heparinized saline compared with those flushed with normal saline.A study was conducted by Harahan Berends (2000) to evaluate the efficacy of saline versus ten units/ml heparin for peripheral intravenous flushes among 240 neonates of Special Care Nurseries at a take III Large Mid Western University Teaching Hospital. Here an experimental group design was used to compare the longevity of heparin and saline intravenous locks. Data were collected from a convenient sampling technique. Group I rece ived ten units per ml of heparin (n=123) whereas Group II received preservative-free normal saline solution (n=117). The result showed that there was no significant statistical difference in intravenous catheter longevity between intravenous locks flushed with ten units/ml heparin and those flushed with normal saline.Krista Brown, Tay-Uyboco Douglas McMillan (1999) did a randomized controlled trial to determine the relative efficacy and safety of peripheral intravenous locks maintained with heparin saline solutions compared with those maintained with normal saline among 186 neonates at Foot Hills Hospital, Calgary, Alberta. Group I received normal saline (n=93) whereas Group II received heparin saline (n=93). Patients were elect to receive either heparinized saline with five units/ml or 0.3 ml of normal saline, in the intravenous catheter every six hourly, administered by care for staff in a blinded manner. The result showed that there was no difference in catheter lifespan (3924 hour for the heparinized saline group 3422 hour for the normal saline group) and no difference in the number of intravenous catheters per patient (1.9 heparinized group, 1.6 normal saline group). The researcher concluded that there was no difference between heparinized normal saline and normal saline flush in neonates in maintaining the patency of twenty four gauge peripheral intravenous locks.Heilskov, Kleiber Johnson (1998) did a randomized double blind controlled 3-arm trial of heparin and saline for maintaining intravenous locks among ninety neonates at University of Iowa Hospitals and Clinics, USA. The propose of this study was to determine the effects of saline, heparin two units (U) per ml saline, and heparin ten units per ml saline flush solutions on the period of intravenous locks and the incidence of intravenous infiltration in neonates. Group I received heparin two units/ml saline (n=27), Group II received heparin ten units/ml saline flush (n=28) and Group III receive d normal saline (n=25). Catheter flushed at to the lowest degree every six hourly. The outcome measures total hours from the date the intravenous was inserted to the era the intravenous was removed hours from the fourth dimension the intravenous was first flushed to the time the intravenous was removed number of intravenous removed because of infiltration. The result showed that there was no statistical or clinical difference between the three groups for epoch of intravenous therapy or for incidence of complications.Bridget Mudge, Dion Forcsier Mary Jo Slattery (1998) conducted a relative study on heparin and saline flush solutions regarding patency of 24-gauge peripheral sporadic infusion devices. A prospective, non-randomized, sequential, blinded study design was conducted on a pediatric and a neonatal were similar for age, peripheral intermittent intravenous devices (PIID) placement internet state of affairs, irritating substances infused, and initial IV function. The median sequence of catheters flushed with normal saline was 42 hours and with heparin was 35.3 hours. Kaplan-Meier Survival digest bespeakd that the duration of catheters flushed with saline was significantly longer than those flushed with heparin (p = .02). More catheters flushed with heparin were removed because of problems (p = .027). Results of this study suggested that normal saline was more effective than heparin in maintaining the patency of small, 24-gauge catheter.Kotter (1996) conducted a randomized double blind study on heparin versus saline to maintain the patency of intermittent intravenous device maintenance among fifty one neonates including premature neonates, little than one month of age admitted to a level II Neonatal Intensive Care Unit. Group I received ten units/ml heparin (n=27), whereas Group II received normal saline flush (n=24). Catheter was flushed every quarter hourly with heparin or normal saline solutions. The researcher concluded that there was no statistically significant difference in average duration of patency between normal saline-flushed catheters and heparinized saline-flushed catheters. Phlebitis, occlusion, infiltration, and leaking occurred with equal frequency for both solutions.Kulkarni, Elsner, Ouellet Zeldin (1994) investigated a randomized double blind study on heparinized saline versus normal saline in maintaining patency of the radial artery catheter among seventy eight adults in the surgical intensive care unit of Toronto East General orthopaedic Hospital. The objective of the study was to compare the ability of normal saline versus heparinized saline infusion to maintain patency of the radial artery catheter used for monitor blood pressure or multiple blood sampling. Group I (n=40) patients those who were admitted on odd numbered dates received heparinized saline two units per ml and Group II (n=38) admitted on even dates received normal saline, both as continuous flush solutions. At 96 hours of cannula tion, 92% of the catheters in the heparinized saline group were patent compared with 74% in the normal saline group. The result showed that there was no significant difference between flushing with normal saline and heparinized saline in the maintenance of radial arterial line patency.A comparative degree randomized controlled trial was conducted by Robertson (1994) on the intermittent intravenous therapy to determine whether heparinized saline solution was a superior flushing agent to normal saline among152 children between the ages of two months to eighteen years. Group I were allocated with heparinized saline as a flushing agent, and Group II were allocated with normal saline as a flushing agent. Each day intravenous situations were examined for signs of phlebitis and on removal of each cannula was flushed to check for fibrin. On Chi-square testing, highly significant associations emerged between the incidence of phlebitis and the use of the intravenous antibiotics such as Tobra mycin (p=0.05) andor Timentin (p=0.008). Young children were install to have a significantly higher incidence of blocked cannulae heedless of the flushing solution used. The researcher concluded that there was no significant difference detected in either the duration of intravenous therapy, the patency of the intravenous line or the incidence of phlebitis when normal saline was used to flush the intravenous cannula.Kleiber, Harahan, Fagan Zittergruen (1993) conducted a double-blind study to determine the efficacy of saline versus heparin flush solution to maintain peripheral intravenous locks in a pediatric population among 124 infants over twenty eight days of age. Group I received normal saline as a flushing agent, whereas Group II received normal saline with heparin as a flushing agent. The result revealed that the heparin and saline groups were comparable for total hour duration of the intravenous and for incidence of complications. Hence the researcher concluded that saline was in effect(p) in maintaining patency of intermittent intravenous peripheral intravenous locks in children.A comparative study was conducted by Rob, Kelly Trish (1992) on normal saline or heparinized saline flushing on function of arterial lines among sixty-five patients in most New Zealand intensive care units. Group I received normal saline (n=35) where as Group II received three ml/hour as a continuous flush. The scores for the intravascular line for each patient were summed, and the percentage of the total possible score was calculated. specify study duration was 5.8 and 6.6 days for the normal saline and heparinized saline groups, respectively. pixilated percentage scores were 83% with normal saline group and 82% with heparinized saline group. The statistical findings showed that there was no difference between the groups at 95% confidence interval. Thus researcher concluded that heparin as a continuous flush at three units/hour does not improve the function of arterial l ines compared with a continuous normal-saline flush.A quasi-experimental study was conducted by Tuten Gueldner (1991) on the efficacy of normal saline versus diluted heparin for maintaining the patency of peripheral intermittent intravenous devices in hospitalized medical-surgical patients among seventy seven children. Group I received normal saline solution, whereas Group II received diluted heparin. The statistical findings revealed that there were no incidence of site injustice due to coagulation in either group, moreover no significant difference in the incidence of site loss associated with phlebitis (p=0.708) or infiltration (p=0.910). The researcher concluded that normal saline may be an effective substitute(a) to heparin, for maintaining the patency of peripheral intermittent intravenous devices.Ashton, Gibson Summers (1990) conducted a randomized double-blind study on the effects of heparin versus saline solution on intermittent infusion device irrigation at Shawnee Mis sion Medical Center among thirty two patients. The purpose of this study was to compare the strong point of one ml of 0.9% normal saline with ten units of heparin in one ml normal saline solution, in maintaining patency and step-down the incidence of phlebitis in patients with intermittent infusion devices. The statistical findings revealed that there was no significant difference between the groups in phlebitis or patency variables. The researcher suggested that 0.9% normal saline was as effective as ten units per ml of heparin in normal saline solution in maintaining intermittent infusion device patency and preventing phlebitis.Hamilton, Plis, Clay Sylvan (1988) conducted a randomized double-blind study on heparin saline versus 0.9% normal saline shooter for maintaining patency of indwelling intermittent infusion devices in the Department of chemists shop practice, Albany College among 307 adult patients. Group I received one ml of heparin saline as a flushing solution (n=170 ), whereas Group II received 0.9% normal saline flush solution (n=137). The result revealed that heparin offers no advantage over 0.9% normal saline injection in maintaining the patency of intermittent intravenous devices. The researcher concluded that there was no significant difference in the duration of catheter patency or incidence of phlebitis was observed between the groups.Epperson (1984) did a randomized study on the efficacy of 0.9% normal saline with and without heparin for maintaining indwelling intermittent injection sites in the medical and surgical units of an acute-care hospital among 412 patients. Three different solutions were used to flush intravenous catheters. Group I were flushed with 0.9% normal saline alone, Group II were flushed with heparin 10 units/ml in 0.9% normal saline and group III were flushed with heparin 100 units/ml in 0.9% normal saline. Heparin locks were flushed after each practice of medicine administration and every eight hours when medicatio ns were not being given. exploitation a standardized evaluation form, one of five intravenous therapists evaluated each site daily for the presence of phlebitis and loss of patency. Length of catheter placement and the percentage of patient days during which patients received cephalosporin and penicillin antibiotics were examined for each group. Rates of site loss caused by phlebitis or loss of patency were compared in each group. The result showed that there was no significant differences were found among the three groups in the slopped duration of heparin-lock placement, the percentage of patient days during which antibiotics were prescribed, or the rate of site loss caused by phlebitis or loss of patency.Section B Literature Related to Cost Effectiveness of Normal Saline in forethought of Peripheral Intravenous Catheter.Hephzibah Alexander (International Journal for the Advancement of Science Arts, 2010) conducted a systematic review of the study on heparin versus normal sali ne as a flush solution. The electronic database of Ovid, Pub-Med, the Cochrane Library and the Cochrane Database of Systematic Reviews (CDSR) was searched for heparin or normal saline (either singly or in combinations). germane(predicate) studies were critically appraised and evidence obtained was graded according to the modified Catalan chest for Health Technology Assessment scale (CAHTA). In terms of safety, the findings indicate that it might be safer to use normal saline as it does not have the risks associated with heparin. Cost analysis studies proved that without any doubt the use of normal saline flush results in a significant follow of cost savings. For arterial catheters, majority of the available data suggest that heparin saline given as a continuous flush at low doses improved catheter patency. The result of the study revealed that normal saline should be used as an alternative to heparin in intravenous catheters. Low-dose heparin with 0.25 units per ml normal saline should be added to the infuscate to maintain patency of arterial catheters. The researcher concluded that heparin as an intermittent flush was ineffective and normal saline was just as effective as and more efficacious than heparin.Karen Le Duce (1997) investigated a prospective, randomized, double blind controlled trial on the efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children at the emergency section of childrens hospital, USA among 150 children. The purpose of this study was to establish the effects of heparin flush and saline solution flush solutions in maintaining patency of infusion devices in the pediatric population, and to establish cost-saving implications related to normal saline solution versus heparin flush for PIIDs in terms of pharmacy cost and costs related to nursing time to both procedures. Group I (n = 77) received 3 ml of a ten units heparin/ml normal saline solution intravenous flus h whereas Group II (n = 73) received three ml of normal saline solution for the intravenous flush. descriptive and correlation statistics were used to analyze the data. The result showed that there were no significant differences between the two groups for demographics or complications. Annual cost savings were computed with an estimated one-year savings of nursing time and unit cost of solutions equaling $27,594. The researcher concluded that the normal saline solution should be used as an alternative to heparin solutions for the maintenance of peripheral intravenous devices.Jerri Shoaf Sandra Oliver (1997) did a study on the efficacy of normal saline with and without heparin for maintaining intermittent intravenous site in the coronary care unit of Scott and White Memorial Hospital among two hundred and sixty surgical patients. Group I received normal saline with heparin as a flushing agent, whereas Group II received normal saline without heparin as a flushing agent. The researc her concluded that heparinized saline was not needed to maintain the patency of an intermittent intravenous site, and the use of saline solution alone was less irritating, causes less occurrence of phlebitis, less expensive to patients, and saves nursing time.A randomized comparative study conducted by Paisley et al (1997) on the use of heparin and normal saline flushes in neonatal intravenous catheters among eighty seven preterm and term infants ranging from 33 weeks to 44 weeks of gestation in the University of Missouri-Columbia Childrens Hospital. Data were collected between February 1994 and March 1995. The majority of infants were thirty eight to forty weeks gestation (M = 38.46 weeks, S.D. = 2.48). Group I (n=33) infants received 0.6 ml of heparin solution containing 10 units/ml of heparin and Group II (n=54) received 0.6 ml of normal saline as flushing agent. The frequency of flush was 0.6 ml flush every fourth hourly. The researcher concluded that the normal saline was much cheaper than heparin. Nursing time was saved using a single solution and physician spends time in writing order was saved by standing orders. If single normal saline was used, the chance for error, over dosage, heparin-associated drug incompatibilities and heparin induce thrombopenia would be eliminated.Section C Literature Related To Complications Of Using Heparin Solution For Maintaining Patency.Mitchell et al (2009) conducted a study on a systematic review of heparin flushing and other interventions to maintain patency of exchange venous catheters. The objective of this study was to assess clinical studies comparing the effectiveness of different means of maintaining primal venous catheter patency. A search was conducted using the MEDLINE, CINAHL, EMBASE, Cochrane, National Guideline Clearinghouse and University Health System Consortium databases. The method was a systematic review of effectiveness using grade criteria to assess the strength of evidence for each intervention. Flushing with heparin was a routine part of central venous catheter maintenance, but it presents risk, including heparin-induced thrombocytopenia. Other techniques used to prevent occlusion of catheters allow in saline flushes, heparin-bonded catheters and pressure caps. The result showed that flushing catheters with saline solution was more effective than flushing with heparin.A study was conducted by Stephens et al (1997) on normal saline versus heparin flush for maintaining central venous catheter patency during aphaeresis charm of peripheral blood stem cells (PBSCS) among seventy eight cancer patients. The purpose of this study was to examine the incidence of thrombotic occlusions in central venous catheters using heparin compared to saline flushing. Group I (n=29) received saline flushes and Group II (n=49) received heparin with 100 units per ml of saline flushes. many studies comparing heparin to saline flushing in peripheral devices suggested equal rates of thrombotic occ lusions. The outcome of the study suggested that serious complications including drug interactions and heparin induced thrombocytopenia and thrombosis syndrome in association with heparin flushing. The researcher concluded that saline was as effective as heparin for maintaining patency of central venous catheters.Triolo, Pamela Goode (1991) conducted a study on meta-analysis to estimate the effects of heparin flush and saline flush solutions on maintaining patency, preventing phlebitis, and increasing duration in peripheral heparin locks. The researcher concluded that saline was as effective as heparin in maintaining patency, preventing phlebitis, and increasing duration in peripheral intravenous locks. shade of care can be enhanced by using saline as the flush solution, thereby eliminating problems associated with anticoagulant effects and drug incompatibilities. In addition, an estimated yearly savings of $109,100,000 to $218,200,000 U.S. health care dollars could be attained.Ba rrett Lester (1990) did a double-blinded, cross-over study on heparin versus saline flushing solutions for a period of two months in a small community hospital at Aroostook Medical Centre, Presque Isle. radical nurses were used as observers and observe catheter failures, as either loss of patency or phlebitis. Data revealed a statistically significant advantage to using saline flushes when both loss of patency and phlebitis were combined (p