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HEPARIN 1










Normal Saline vs. Heparin
Maureen D. Amilca
University of South Florida















Running head: NORMAL SALINE VS. HEPARIN 2
Normal Saline vs. Heparin
In hospitals, heparin has been used as a locking solution for those with venous
access port. This type of flush allow for patency by preventing blockage in catheters from
IV medications. However, Heparin flush can cause complications with certain
medications, Heparin Induced Thrombocytopenia (HIT) and bleeding. According to
Pesaturo (2013), .3-3% of patient treated with heparin will develop HIT. In hospitalized
patients with venous access, how does using normal saline as compared to heparin as a
locking solution affect access, patency, and complication rates during hospitalization?
Being a magnet hospital itself, Sarasota Memorial Hospital makes sure they are
providing quality care to their patients and also staying on top of new evidence based
practices. Supporting the changes in this practice will be those who are health
professionals such as doctors and nurses, and researchers at the SMH. The doctors will
make the orders, and nurses will implement. As a team they will communicate and
educate one another on the importance of using normal saline in place of heparin as a
flush.
Synthesis Literature Review
The research engine used in this evidenced based practice synthesis was PubMed.
Key words were Heparin lock, Normal Saline lock, flush, patency and catheter.
The purpose of this evidenced based practice synthesis is to show that normal
saline flush can be used as a replacement of heparin flush in hospital patients with venous
access. The reason for this practice is to reduce complications such as infections, heparin-
induced thrombocytopenia and thrombosis syndrome. All the articles reviewed concluded
that normal saline can be or may be used as an alternative for heparin in hospitalized
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patients. For example in both projects of Bertoglio et al. (2012) and Goosens et al.
(2013), their focus was on cancer patients. With this population, it is essential that
catheters are patent due to the fact these patients are at high risk to getting sick from
being immune suppressed. In addition, Betoglio et al. study states some benefits of
normal saline usage such as prefilled saline syringes because it is easier to use and having
a positive pressure. Having prefilled saline syringes allows a quicker rate for nurses to
flush access ports. Goosens et al. had an end result that demonstrated a higher rate of
infection in patients who were flushed with heparin compared to those flushed with
normal saline. This result supports how Heparin has a higher complication risk. Viewing
Cook, Bellini and Cusson (2011) study is vital to this evidence based practice because it
was focused on another group of participants: newborn babies. This end result showed
that ports flushed with normal saline had a 13 hour longer patency than those flushed
with Heparin. Longer patency allows continuous arterial or venous access for health
professionals, also fewer times of changing location of arterial or venous access. In Goh,
Teo, and Masagoes (2011) study, their goal were similar to the others outcome which was
decreasing complications and having backflow. Their participants were those in neuro
intensive care. This practice was different compared to the other studies because it was
practiced in a different country. Practicing this in another country may have some cultural
factors that may inhibit some practice. This study was very strong, because they focused
on certain hours and explained which vessels (arterial or venous) were still patent and the
amount that was still patent. For instance, arterial lines after 72 hours that were patent for
NS was 35 and in after 120 hours it was at 30. This article was well detailed. Most of the
studies explained their limitation such as those with participants with health problems, or
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those who were excluded. They all properly described their purpose, methods and
outcome which was normal saline as an alternative of heparin.
Proposed Practice Change
In hospitals, the usage of heparin as a flush solution should be replaced with
normal saline. Normal saline flush solution will be administered to patients with venous
or catheter access. Before and after medications are administered into a port, normal
saline will be given to check for patency. Less or no signs of occlusion, infection and
complications such as HIT will determined the effectiveness of normal saline as solution
flush.
Change Strategy
To promote engagement in this change, a one-day, paid workshop will be created.
At the workshop, there will be essential information provided for the change of heparin to
normal saline. In addition, health care professionals may engage in any concerns or
recommendation to this innovation. The IOWA model will be used to approach change
because this tool can help guide health professionals on identifying problems and
developing solutions.
Roll Out Plan
Step 1 Assess the need for change
in practice.
Speak to health
professionals.
Completed by August, 2013
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Identify problem.

Step 2 Locate best evidence.
Find research within
5 years supporting
PICOT.
Find plan that will
be used such as
IOWA plan.
Complete September, 2013
Step 3 Create synthesis Complete October, 2013
Step 4 Design practice
change.
Create local and
regionally
workshops and
conferences.
Complete November, 2013.
Step 5 Implement and evaluate.
Health professionals
start to use normal
saline in place of
Heparin.
Complete by end of April,
2014
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Evaluate the process
and outcome.
Conclusion: normal
saline be used as an
alternative for
heparin flush due to
less complications?
Step 6 Integrate change.
Brochure and
posters will be
created for local and
regional hospitals..
Integrate to practice.
Continue to monitor.

Complete by May, 2013.

Project Evaluation
Specific data that should be collected as an outcome are the amount of occlusion,
rate of infection and percentage of complications that occur in patients that are being
flushed with normal saline. To indicate success or failure, after a patient is flushed with
normal saline, nurses need to collect information on the flushing process. Nurses need to
describe and count for any non-patency catheters, such as redness or occlusion. Also
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while taking vitals, nurses should look note if there is an increase of temperature.
Increase of temperature may relate to infection. There should be a decrease rate in
infection, complications and occlusions.

Dissemination of EBP
A method planned to disseminate the change locally and regionally is to create a
conference. For Sarasota Memorial Hospital, there will be a workshop created for nurses.
For other units, posters and brochures will placed in the units, for health professionals to
read and take into consideration.











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References
Bertoglio, S., Solari, N., Meszaros, P., Vassallo, F., Bonvento, M., Pastorino, S., &
Bruzzi, P. (2012). Efficacy of normal saline versus heparinized saline solution for
locking catheters of totally implantable long-term central vascular access devices
in adult cancer patients. Cancer Nursing, 35(4), E35-E42.
Cook, L., Bellini, S.& Cusson RM. (2011). Heparinized saline vs. normal saline for
maintenance of intravenous access in neonates: An Evidence-Based Practice
Change: Volume 11(3).
Goh, L., Teo, H.& Masagoes, M. (2011). Heparinised saline versus normal saline in
maintaining patency of arterial and central venous catheters: Volume 20 Number
3.
Goossens, A., Jerome, M., Janssens, C., Peetermans, E., Fieuws, S., Moons, PStas, M.
(2013). Comparing normal saline versus diluted heparin to lock non-valved totally
implantable venous access devices in cancer patients: A randomised, non-
inferiority, open trial-Annals of Oncology 24(7), 1892-1899.
Heparin-induced thrombocytopenia (2013.) Ubound Medicine (Version 2.2.23). [Mobile
application software]





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