Heparin flushes

The use of heparin has suddenly come under the spotlight in the UK. However, the reason for this attention is different to previous concerns in countries such as the US.

“An independent report has recently been published reviewing the circumstances of four patient safety incidents where an anaesthetist mis-selected sodium heparin 25,000 units in 5 ml (Monoparin) instead of sodium heparin 50 units in 5 ml (Hepsal) and administered the more concentrated solution in unlabelled syringes to four children. Thankfully the four children only experienced some temporary bleeding and otherwise are not reported to have suffered longer term harm. However, the potential for serious harm was recognised by the hospital trust” (NPSA 2008).

The NPSA state:

• Organisations should review local policies to minimise the use of heparin flush solutions in all devices, including complex central venous or arterial catheters.  This should take into account the evidence reviewed by UK Medicines Information (UKMi) which confirms that heparin flushes should not normally be used to flush peripheral intravenous catheters.  
• All flush solutions should only be administered following a prescription or patient group direction.
• Local policy and procedures should be reviewed to ensure risk with heparin flush solutions is minimised.
• Healthcare organisations should ensure that all relevant staff are made aware of this guidance and revised policy.

The Rapid Response Report from the NPSA can be viewed here and further support information can be viewed here.

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