SAFE AND EFFECTIVE USE OF HEPARIN IN NEONATAL PATIENTS

To support the development and use of nationally standardized concentrations of heparin when used for maintenance and flush of peripheral and central venous lines in neonatal patients; further,

To advocate that hospitals and health systems use manufacturer-prepackaged heparin flush products to improve the safe use of heparin in neonatal patients.

Rationale

The preferential use of saline to maintain peripheral lines and devices in adult patients has largely become the standard of care, but use of heparin in neonates continues because of a lack of consensus and perceived and actual limitations in the evidence in published literature. However, fatal medication errors caused by the use of heparin in this patient population have brought to the forefront concern that the risks of using heparin for this purpose may outweigh the potential benefits. The ASHP Therapeutic Position Statement on the Institutional Use of 0.9% Sodium Chloride Injection to Maintain Patency of Peripheral Indwelling Intermittent Infusion Devices provides evidence for the use of sodium chloride as the preferred solution for maintaining peripheral lines in adult patients but does not address the use of sodium chloride versus heparin in patients younger than 12 years of age, because at the time of publication there was a lack of sufficient evidence regarding the effectiveness of sodium chloride solution for flushing peripheral lines or maintaining their patency in neonatal and pediatric patient populations.

ASHP’s Council on Therapeutics has reviewed evidence from evaluations of the use of 0.9% sodium chloride and heparin to maintain and flush arterial and central lines in neonatal patients and reports of medication errors that involved heparin. The advantages of saline include greater compatibility than heparin with concurrently administered drug therapies, lower product costs, fewer potential adverse drug events (e.g., heparin-induced thrombocytopenia, a rare but potentially fatal event for neonatal patients), and prevention of potential medication errors related to improper selection or dilution of heparin products. Advantages of heparin use include extended line patency and a beneficial antithrombotic effect at the insertion site. The data are conflicting and insufficient to support the recommendation of a preferred solution for line maintenance in neonatal patients at this time. The development of standardized concentrations of heparin to decrease practice variation and the use of manufacturer-prepackaged products are the best ways to improve the safe use of heparin in neonatal patients.