1. Arterial catheter audit C Doherty, J Rigg, J Boulton Critical Care Unit, Stockport NHS Foundation Trust 28 th November 2011

3. 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

4. Evidence Clifton GD et al (4) DB RCT 30 patients saline versus heparin 4u/ml, flow 3ml/hr. Sig difference in catheter survival rates with hepsal resulting in longer patency Whitta RKS et al (5) RCT 65 patients. Saline versus hep 1u/ml, flow 3ml/hr.No difference in life span or function American association of Critical care nurses (6) RCT hep versus saline.5139 patients. Sig difference. Hepsal better Patency, longer lifespan

7. Regional practice

8. 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

9. Audit progress Audit ran for two consecutive six week periods between October 1 st and December 31 st 2010 128/130 potential patients reviewed 157 arterial catheters were valid for analysis

10. Reason for removal

11. Demographics

12. Site of insertion

15. Main results p value Chi 2 test = 0.000

16. Lifespan of arterial catheters p value Mann Whitney U test = 0.000

17. Consequences

18. 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

19. References 1.Rapid Response Report NPSA/2008/RRR002. Natioanl Patient Safety Agency. April 2008 2.Ashton J et al. Effects of heparin versus saline solution on intermittent infusion device irrigation. Heart Lung. 1990;19:608-612 3.Niesen KM et al. The Effects of heparin versus normal saline for maintaining peripheral intravenous locks in pregnant women. J Obstet Gynecol Neonatal Nurs. 2003;32:503-508 4.Clifton GD et al. Compariosn of normal saline and heparin solutions for maintenance of arterial catheter patency. Heart Lung. 1991;20:115-118 5.Whitta RKS et al.Comparison of normal or heparinised saline on function of arterial lines. Crit Care Resusc. 2006;8:205-208 6. American association of Critical care nurses. Evaluation of the effects of heparinised and nonheparinised flush solutions on the patency of arterial pressure monitioring lines: the AACN Thunder Project. Am J Crit Care. 1993;2:3-15.