Transcript Maintaining Arterial Catheters with Normal Saline

Maintaining Arterial Catheters
with Normal Saline
Catherine Williams
MSN student
A research based protocol
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The Stetler model was used for this protocol
Phase I: Introduction
Phase II: Validation
Phase III: Comparative Evaluation/Decision making
Phase IV: Translation/Application
Phase V: Evaluation
Abstract
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Arterial catheters are used in critical care units to continuously
monitor blood pressures and to obtain blood samples without
performing multiple venipunctures. For decades arterial
catheters have been maintained with a pressurized heparinised
0.9% normal saline to prevent thrombus formation. The use of
heparin for its pharmacological properties as an anticoagulant.
Research evidence indicates that short term arterial lines may
be maintained effectively and at a reduced cost by using normal
saline instead of heparinised saline.
Phase : I Introduction
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The risks associated with the routine use of heparin
are abnormal coagulation studies, bleeding, heparin
induced thrombocytopenia or HIT, embolic events
and death.
In the critical care setting 23-41% of patients will
have an incidence of thrombocytopenia. Mortality
rates related to thrombocytopenia in the ICU are
between 38-54%( Napolitano,L.M.,2006).
Phase II: Validation
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Five studies found that examine this subject.
Hook and colleagues’(1987) study using quasi- experimental
design, patency [dependent variable], type of solution
[independent variable] N=50. Two groups one group with
catheters maintained with ringers lactate the other with
heparinised saline. Nurses were instructed to flush the nonheparinised catheters every hour even though both groups lines
were under continuous pressure via pressure bag at
300mmHG.
Results concluded that arterial catheters can be maintained
with out the use of heparin in short term catheters.
Literature Review
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Heparin as a continuous flush at 3units/hr does not
improve function of arterial lines compared with
continuous flushing with normal saline( Hall,K.,et
al,2006).
Prospective double blind study compared the effects
of heparinised and 0.9% normal saline both
administered via continuous flush device to an
arterial catheter, N=65. Comparison using central
limit theorem showed means were not different at the
95% confidence interval(Hall,K.,et al,2006).
Phase:III
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Feasability: Potential risks of occlusion of catheters.
Investigation of current practices at UVA, MCV and Duke
University all confirm the use of 0.9% normal saline without the
use of heparin for all pressure lines to include arterial, CVP, and
Swan Ganz catheters.
Largest study done in 1993 The AACN Thunder Project
promotes the use of heparin in all pressure lines.
Presentation of findings to Critical Care committee.
Recommendation : 0.9% normal saline to be used in all
pressure lines, no trial recommended.
Phase: IV Translation/Application
Phase: V Evaluation
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Presented to policy and procedure
committee.
Nursing policy 11.06 [normal saline used in
all pressure lines at Centra Health].
Annual cost savings $25,174.80
Evaluation will be ongoing staff instructed to
notify Mary Ann Tate CNS for any problems
related to catheters.
Conclusion
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Applying research and related evidence to nursing
practice to promote better patient outcomes, save
money and to avoid the use of additional sometimes
harmful medications.