Heparin usage in IVF and TPN

Low-dose continuous heparin administration has been shown to prolong the patency of umbilical central lines, although it does not decrease incidence of thrombosis associated with these lines. By inference, it is assumed (although not proven) that low dose heparin infusion should prolong patency of percutaneously placed central venous lines (PICCs.)

At Vanderbilt, heparin in a concentration of ¼ Unit/cc is added to all iv fluids being administered by UAC, UVC, or PICC. Higher concentrations of heparin ( ½ Unit/cc) may be administered through a peripheral arterial line. Heparin in these concentrations does not cause a coagulopathy or increase the incidence of IVH in premature infants.

Heparin also promotes lipid clearance and metabolism in infants receiving parenteral Intralipid by releasing lipoprotein lipase from the endothelial cells. Therefore, ¼ Unit/cc heparin should also be added to TPN/IL being administered via a BROVIAC® catheter*.  Indeed, if an infant is having difficulty tolerating lipid infusions, ¼ Unit/cc heparin can be safely administered even through a peripheral IV.

References:

Barrington KJ. Umbilical artery catheters: heparin usage.  http://www.nichd.nih.gov/cochrane/Barring3/Barring3.htm

Shah P and Shah V. Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. http://www.nichd.nih.gov/cochrane/shah4/shah.htm

Chang GY, et al. Heparin and the risk of intraventricular hemorrhage in premature infants. J Pediatr 1997; 131: 362-6.

Spear ML, et al. Effect of heparin dose and infusion rate on lipid clearance and bilirubin binding in premature infants receiving intravenous fat emulsions. J Pediatr, 1998; 112: 94-8.

* BROVIAC® is a registered trademark of C.R.Bard, Inc. and its related company, BCR, Inc.

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