Heparin Use with Arterial Lines

Evidence for Saline vs. Heparinized Flush

Maintaining adequate arterial waveform quality for hemodynamic monitoring is achieved with continuous normal saline flush, eliminating the need for heparinized saline and its associated risks, as recommended by the American Association of Neurological Surgeons 1
The use of heparinized saline for arterial line maintenance increases the risk of heparin-induced thrombocytopenia (HIT), which occurs in up to 5% of patients receiving unfractionated heparin, according to the American College of Physicians 2

When systemic anticoagulation is indicated, administer unfractionated heparin as a 60 U/kg bolus (maximum 4000 U) followed by 12 U/kg/hour continuous infusion (maximum 1000 U/hour), with a target aPTT of 1.5-2.0 times control, as suggested by the American College of Cardiology 3
For arterial procedures, use weight-based dosing of 70 U/kg bolus to achieve ACT 200-300 seconds, as recommended by the American Heart Association 1, 4, 5

When initiating therapeutic heparin, measure baseline aPTT, INR, and platelet count, and monitor platelet counts daily to detect HIT, as advised by the American Society of Hematology 3
Check aPTT every 4 hours initially, then at appropriate intervals for continuous IV infusion, and before each injection for intermittent IV dosing, as recommended by the American College of Chest Physicians 3

In patients with renal insufficiency (creatinine clearance <30 mL/min), unfractionated heparin is preferred over low-molecular-weight heparin, as suggested by the National Kidney Foundation 6
In pediatric patients, use preservative-free heparin, and target aPTT 60-85 seconds (anti-Factor Xa 0.35-0.70), as recommended by the American Academy of Pediatrics 6