29 Effect on safety and cost in switching from heparinised to non-heparinised saline during angiography

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Abstract

Background

Heparinised saline has been used to flush lines during coronary angiography to reduce the risk of sheath thrombus formation and distal embolic events. A National Patient Safety Agency alert in 2008 cautioned against the use of intravenous heparin flush. Data is limited for intraarterial flushes. The rise in radial access interventions (with routine systemic unfractionated heparin (UFH) administration) prompted a service improvement program (SIP) where the use of heparinised saline for diagnostic cardiac angiographic procedures was exchanged for a 2–3000 unit UFH bolus.

Methods and Results

The audit focused on diagnostic femoral angiography (FA) as this group was felt to be the most vulnerable. Retrospective data collected from 2 patient cohorts undergoing FA prior to and post SIP included use of oral anticoagulation or antiplatelet agents, eGFR and an estimate of heparin delivered via the flush (pre SIP) or actual UFH bolus administered intraarterially (post SIP). All documented catheter-associated complications and radiological investigations seeking complication were noted. The pre-SIP cohort received a median of 75 iu heparin. 22/30 patients in the post-SIP group received UFH boluses; the median dose was 3000 iu. No thrombotic complications were documented in either group.

Conclusion

Although thrombotic complications are fairly rare, this audit supports the safe use of normal saline with an UFH bolus during angiography. Extrapolated to include diagnostic cases and angioplasty, the switch to normal saline with UFH bolus is projected to save in excess of £77 000 per year in our institution.

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