Elsevier

Journal of Critical Care

Volume 60, December 2020, Pages 253-259
Journal of Critical Care

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

https://doi.org/10.1016/j.jcrc.2020.08.025Get rights and content

Highlights

  • Critically ill COVID-19 patients have frequent arterial line (a-line) thrombosis.

  • A low dose heparinized saline (LDHS) a-line patency protocol was examined.

  • Two a-line thrombosis cohorts were identified: “post-LDHS” and “pre-LDHS”.

  • A-line patency was longer in post- vs. pre-LDHS patients (8.5 vs. 2.9 d; p < 0.001).

  • Bleeding complications were similar between groups (13% vs. 10%, p = 0.7).

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

Abbreviations

COVID-19
Coronavirus Disease 2019
DVT
deep vein thrombosis
PE
pulmonary embolism
ICU
intensive care unit
LDHS
low dose heparinized saline
SOFA
Sequential Organ Failure Assessment
PTT
partial thromboplastin time
INR
international normalized ratio
CRP
C-reactive protein
CRNMB
clinically relevant non-major bleeding
IQR
interquartile range

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