J Crit Care . A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients

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J Crit Care


. 2020 Sep 2;60:253-259.
doi: 10.1016/j.jcrc.2020.08.025. Online ahead of print.
A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients


Lydia R Maurer ¹ , Casey M Luckhurst ¹ , Arzo Hamidi ² , Kelly A Newman ² , Megan E Barra ² , Majed El Hechi ³ , Ava Mokhtari ³ , Kerry Breen ³ , Laura Lux ⁴ , Laura Prout ⁴ , Jarone Lee ⁵ , Edward A Bittner ⁶ , David Chang ⁷ , Haytham M A Kaafarani ³ , Rachel P Rosovsky ⁸ , Russel J Roberts ⁹



Affiliations

• PMID: 32920504
• DOI: 10.1016/j.jcrc.2020.08.025

Abstract

Purpose: Critically ill patients with Coronavirus Disease 2019 (COVID-19) have high rates of line thrombosis. Our objective was to examine the safety and efficacy of a low dose heparinized saline (LDHS) arterial line (a-line) patency protocol in this population.
Materials and methods: In this observational cohort study, patients ≥18 years with COVID-19 admitted to an ICU at one institution from March 20-May 25, 2020 were divided into two cohorts. Pre-LDHS patients had an episode of a-line thrombosis between March 20-April 19. Post-LDHS patients had an episode of a-line thrombosis between April 20-May 25 and received an LDHS solution (10 units/h) through their a-line pressure bag.
Results: Forty-one patients (pre-LDHS) and 30 patients (post-LDHS) were identified. Baseline characteristics were similar between groups, including age (61 versus 54 years; p = 0.24), median Sequential Organ Failure Assessment score (6 versus 7; p = 0.67) and systemic anticoagulation (47% versus 32%; p = 0.32). Median duration of a-line patency was significantly longer in post-LDHS versus pre-LDHS patients (8.5 versus 2.9 days; p < 0.001). The incidence of bleeding complications was similar between cohorts (13% vs. 10%; p = 0.71).
Conclusions: A LDHS protocol was associated with a clinically significant improvement in a-line patency duration in COVID-19 patients, without increased bleeding risk.

Keywords: COVID-19; Critical illness; Heparin; Thrombosis; Vascular access devices.