Heparin or saline for arterial line patency?

Normal saline is generally preferred over heparinised saline for maintaining arterial line patency due to fewer risks.

There is limited high-quality evidence favouring one over the other, but heparinised saline carries increased risks, including:

• Heparin-induced thrombocytopenia (HIT)
• Inaccurate blood sampling from residual heparin in the line

Heparinised saline may be considered in patients without HIT risk who require long- term arterial access.

Keep in mind, correct insertion technique, location and ongoing management can greatly reduce complications.

Note: Heparin is often derived from animal products (e.g. porcine). Check for any religious or cultural concerns with the patient before use.

References:

Everson, M., Webber, L., Penfold, C., Shah, S., & Freshwater-Turner, D. (2016). Finding a solution: Heparinised saline versus normal saline in the
maintenance of invasive arterial lines in intensive care. J Intensive Care Soc,17(4), 284-289. https://doi.org/10.1177/1751143716653763

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., &; Ong, J. (2024). Infusion therapy standards of practice. Journal of Infusion Nursing, 47(1S), S1-S285.

Robertson?Malt, S., Malt, G. N., Farquhar, V., & Greer, W. (2014). Heparin versus normal saline for patency of arterial lines. Cochrane Database of Systematic Reviews(5). https://doi.org/10.1002/14651858.CD007364.pub2

Woodcock, T., Cook, T., Gupta, K., & Hartle, A. (2014). Arterial line blood sampling: preventing hypoglycaemic brain injury 2014: The Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 69. https://doi.org/10.1111/anae.12536

Ziyaeifard, M., Ferasat-Kish, R., Azarfarin, R., Aghdaii, N., Nejatisini, H., Azadi Ahmadabadi, C., & Yousefi, M. (2022). Comparison of the Effect of Heparinized Normal Saline Solution Versus Saline Solutions in Arterial and Central Venous Catheters on Complete Blood Count After Cardiac Surgery. Anesth Pain Med, 12(4), e113345. https://doi.org/10.5812/aapm-113345
 

Last Updated on: 31/07/2025

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