Original Study

Journal of Veterinary Emergency and Critical Care 23(5) 2013, pp 517522

doi: 10.1111/vec.12093

Comparison of heparinized saline and 0.9%

sodium chloride for maintaining peripheral
intravenous catheter patency in dogs
Yu Ueda, DVM; Adesola Odunayo, DVM, MS, DACVECC and F.A. Mann, DVM, MS, DACVS,
DACVECC

Abstract

Objective To determine whether heparinized saline would be more effective in maintaining the patency of
peripheral IV catheters in dogs compared to 0.9% sodium chloride.
Design Prospective blinded randomized study.
Setting University Veterinary Teaching Hospital.
Animals Thirty healthy purpose bred dogs, intended for use in the junior surgery laboratory, were utilized.
The dogs were randomized into 1 of 3 groups, 2 treatment groups and a control group.
Interventions An 18-Ga cephalic catheter was placed in the cephalic vein of each dog. Each dog in the
treatment group had their catheter flushed with either 10 IU/mL heparinized saline or 0.9% sodium chloride
every 6 hours for 42 hours. The dogs in the control group did not have their catheters flushed until the end of
the study period. Immediately prior to flushing catheters, each catheter was evaluated for patency by aspiration
of blood and the catheter site was evaluated for phlebitis.
Measurements and Main Results All dogs in the heparinized saline and 0.9% sodium chloride group had
catheters that flushed easily at each evaluation point. More dogs in the saline group had catheters from which
blood could not be aspirated, but there was no significant difference between these groups. All dogs in the
control group had catheters that flushed easily at the end of the assigned 6 hour interval except in 1 dog.
Phlebitis was not detected in any dog.
Conclusions Flushes of 0.9% sodium chloride were found to be as effective as 10 IU/mL heparinized saline
flushes in maintaining patency of 18-Ga peripheral venous catheters in dogs for up to 42 hours. For peripheral
catheters placed with the intention of performing serial blood draws, heparinized flushes may be warranted.
(J Vet Emerg Crit Care 2013; 23(5): 517522) doi: 10.1111/vec.12093
Keywords: catheter care, blood sampling, thrombophlebitis

Introduction
Peripheral IV catheters are indispensable lifesaving tools
commonly used in hospitalized human and veterinary
patients to administer fluids, medications, and parenteral nutrition.17 Medical personnel in the ICU work
From the Department of Clinical Sciences, Auburn University, Auburn, AL
36849 (Ueda, Odunayo); Department of Veterinary Medicine and Surgery,
University of Missouri, MO 65211 (Mann).
Dr. Uedas current address is School of Veterinary Medicine, University of
California, Davis, CA.
Dr. Odunayos current address is College of Veterinary Medicine, University
of Tennessee, Knoxville, TN 37996.
The authors declare no conflict of interests.
Address correspondence and reprint requests to
Dr. Adesola Odunayo, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996. Email: adesolaodunayo@yahoo.com
Submitted December 15, 2011; Accepted August 1, 2013.


C Veterinary Emergency and Critical Care Society 2013

to ensure that these devices remain patent during the

patients stay in the hospital. Loss of IV catheter patency
may lead to compromised patient care, increased costs
associated with replacing the catheters, and increased
patient discomfort.3, 8, 9
Occlusion and catheter site phlebitis are 2 common
complications associated with peripheral IV catheters in
human and veterinary patients.10, 11 Catheter occlusion
is thought to occur due to factors such as catheter site
infection, duration of catheterization, or patient-related
risk factors. Those factors ultimately lead to thrombus
formation.12 A great deal of work has been devoted
to develop different catheter materials that minimize
activation of coagulation.13 Catheter clot formation
has also traditionally been addressed by filling and
flushing catheters with solutions with anticoagulant
properties such as heparin, citrate, and vitamin C.12 In

517

Y. Ueda et al.

human patients, complications associated with the use

of heparin in flush solutions include drug interactions,
heparin-induced thrombocytopenia, bleeding complications, thrombosis syndrome, and allergic reactions.1518
Many studies in human patients have shown that the use
of heparinized saline does not provide any additional
benefit over the use of 0.9% sodium chloride flushes
in peripheral catheters,8, 9, 1922 although a few studies
show that heparin may have a protective effect against
catheter clot formation.14, 23 These studies have led many
human hospitals to discontinue the use of heparin in peripheral catheter flushes.8, 9 To the authors knowledge,
there are no veterinary studies comparing the efficacy
of heparinized saline and 0.9% sodium chloride flush.
While there are no known reports of heparin-induced
thrombocytopenia in veterinary patients, there is still a
risk of allergic reactions, drug interactions, and bleeding
complications (eg, inadvertent heparinization).24, 25
The purpose of this study was to determine whether
heparinized saline is more effective than 0.9% sodium
chloride in maintaining the patency of peripheral IV
catheters in dogs. We hypothesized that heparinized
saline (10 IU/mL) would be more effective in maintaining peripheral catheter patency than catheters flushed
with 0.9% sodium chloride.

Methods and Materials

The present study was a prospective, randomized,
double-blinded controlled study. The study protocol was
approved by the Institutional Animal Use and Care
Committee at Auburn University. Healthy purpose bred
dogs intended for use in the junior surgery laboratories
at the authors institution were utilized in this study. All
dogs received a physical examination at the beginning
of the study and were deemed to be healthy based on
their physical examination findings.
An 18-Ga, 1.25-inch over-the-needle polyurethane
cathetera was percutaneously placed in the right cephalic
vein at the distal third of the antebrachium. If the catheter
was unsuccessfully placed in the right cephalic vein, the
left cephalic vein was utilized. All catheter sites were
shaved and the area was aseptically prepared using iodine and alcohol scrubs before the catheters were placed.
All catheter sites were prepared in an identical manner.
The catheters were capped with an infusion plugb and
secured with medical adhesive tape. A transparent sterile dressingc was incorporated in the securement to allow
for catheter site visualization. Immediately after placement all catheters were assessed for patency by syringe
aspiration of at least 0.1 mL of blood and easy injection
of 3.0 mL 0.9% sodium chloride.d An assistant holding
the dog palpated along the cephalic vein to confirm free
flow of the flush solution, while also observing for SC
518

extravasation of the flush solution. An Elizabethan collar was placed on each dog after catheter securement,
and the dogs were constantly monitored directly by an
individual to ensure the catheters were not inadvertently
removed.
The study subjects were randomized into 1 of 3
groups: a heparinized saline groupe (HS), a nonheparinized 0.9% sodium chloride group (S), and a control group that received no flush except that performed
immediately after catheter placement and after the final evaluation (C). The control group was used to help
determine how long after placement thrombosis of the
catheter was likely to occur when left unflushed. Thirty
dogs were enrolled in the present study. Twenty-four
dogs were randomized to the HS (n = 12) and S (n = 12)
groups. Six dogs were randomized in the C group: 2 in
the C12 group, 2 in the C24 group, and 2 in the C42 hour
group. The 12-hour control group (C12) had catheters
aspirated and then flushed with 0.9% sodium chloride
12 hours after the catheters were placed. The 24-hour
control group (C24) had catheters aspirated and flushed
with 0.9% sodium chloride 24 hours after the catheters
were placed, and the 42-hour control group (C42) had
catheters aspirated and then flushed with 0.9% sodium
chloride 42 hours after the catheters were placed. The
catheters were removed from the subjects in the C group
after a single attempt to withdraw blood and flush them
with 0.9% sodium chloride.
Catheter evaluation
All catheter evaluations were evaluated by 1 of 2 investigators (YU or AO). Every dog had its catheter site evaluated for evidence of phlebitis and patency every 6 hours.
Phlebitis was defined as the presence of any of the following: erythema, tenderness, swelling, unusual discharge
or warmth. A rectal temperature was also taken from
each dog during each evaluation. Catheter patency was
evaluated by the ability to aspirate at least 0.1 mL of
blood (while the cephalic vein was occluded proximal
to the catheter) with little resistance. The aspiration was
done prior to the administration of the flush solution.
Patency was also evaluated by the ability to administer
3 mL of flush solution without resistance or SC extravasation through the catheter. All catheters in the S and HS
groups were evaluated for patency in the same manner.
Catheter flushes
All catheter flushes were performed by 1 of 2 investigators (YU or AO). The study solutions were prepared
by 1 of the investigators who was blinded to the treatment groups. Each syringe of study solution was labeled
with a predetermined study code to ensure blinded randomization. The dogs in the HS and S groups had their

C Veterinary Emergency and Critical Care Society 2013, doi: 10.1111/vec.12093

Heparinized saline vs. 0.9% sodium chloride

catheters evaluated and flushed with 3 mL of 10 IU/mL

heparinized saline and 3 mL of 0.9% sodium chloride,
respectively, every 6 hours until the end of the study
period. Once enrolled, the subjects continued to receive
the same study solution throughout the duration of the
study. Catheters were removed upon discovery of nonpatency or at the end of the study. In the HS and S groups,
the subjects were followed for 42 hours from the time of
catheter placement.

Table 1: Summary of proportion of peripheral venous catheters

with successful blood aspiration at different time points in 24
dogs with heparinized saline (n = 12) or nonheparinized 0.9%
sodium chloride (n = 12) catheter flushes (number of catheters
with successful blood aspiration/total number of catheters)

0h

24 h

30 h

36 h 42 h

Heparinized
12/12 12/12 12/12 12/12 11/12 11/11 10/11 9/10
Nonheparinized 12/12 11/12 11/12 10/12 8/12 9/12 7/11 5/10
P value
1
0.5 0.5 0.2391 0.0559 0.1242 0.1378 0.065

Statistical Analysis
A sample size calculation was performed before the
study to determine appropriate sample size. We calculated that 12 dogs would be sufficient to show the
difference between the 2 groups at 80% power with an
alpha < 0.05. Data were analyzed using commercial statistical software.f A stratified 22 contingency table analysis and Fishers exact test were used to evaluate the
differences between the HS and S groups in regards to
blood withdrawal from the catheters. The change in body
temperature of the animals was analyzed using Student
t-test. A value of P < 0.05 was considered significant.

6 h 12 h 18 h

Values of P < 0.05 were considered significant.

discontinued after 24 hours in 1 dog and after 36 hours

in another dog because of inadvertent catheter removal
by the dogs. In the S group, the study was discontinued
after 30 hours and 36 hours in 2 dogs, respectively, due
to inadvertent catheter removal by the dogs.
In both S and HS groups, no dog showed any signs
of phlebitis at the catheter site. In the C group, 1 dog
showed mild erythema in the C12 subgroup and 1 dog
had extravasation of the flush solution in the C42 subgroup at the final evaluation. There were no statistically
significant changes in temperature in the dogs in any
group through the course of the study.

Results
The HS and S groups had 7 female and 5 male dogs each.
The C group had 3 male and 3 female dogs. The average
weight of the dogs was 13.6 kg (SD 3.45 kg) in the HS
group, 16.8 kg (SD 5.50 kg) in the S group, 14.8 kg
(SD 5.27 kg) in the C group.
All dogs in the HS and S groups had catheters that
flushed easily at every time point of evaluation. All dogs
in the C group had catheters that flushed easily at the
end of the assigned 6 hour interval except 1 dog in the
C42 group, whose catheter was deemed to be obstructed
and would not flush with moderate pressure applied.
The proportion of catheters successfully aspirated in
the HS and S groups at different time points is detailed
in Table 1. Despite the difficulty in aspirating blood from
multiple catheters in the S group, there was no statistically significant difference between the HS and S groups
at each time point (Table 1). All dogs in the C group had
blood aspirated from their catheters with minimal resistance except 1 dog in the C42 group. This was the same
dog whose catheter would not flush at the end of the
study period.
All catheters used in the study were placed during the
first attempt to get venous access in the limb ultimately
used for the study. There were technical difficulties associated with placing peripheral catheters in the right
cephalic vein in 4 dogs (1 in the S group and 3 in the
C groups). As a result, those catheters were placed in
the left cephalic vein. In the HS group, the study was

C Veterinary Emergency and Critical Care Society 2013, doi: 10.1111/vec.12093

Discussion
The use of heparin as an antithrombotic agent in
catheters is common in both human and veterinary
medicine.13, 2628 However, despite wide use, the benefit of heparinized flushes in veterinary patients has
not been investigated. Previous investigations in human patients have suggested that intermittent flushing
of IV catheters with nonheparinized saline is equally
as effective in maintaining catheter patency without
significant side effects.8, 1922, 29 In addition, many complications including thrombocytopenia and coagulopathy have been reported with prolonged administration of heparin in human patients.9, 3034 There have
been reports describing serious complications and sometimes fatal outcomes in human patients with heparin
complications.3133, 35 While there are no studies documenting heparin-induced thrombocytopenia in dogs
and cats, this may be a potential risk in small animal
patients. In the present study, no obvious complications
associated with heparin administration, such as petechia
and ecchymosis, were observed during the study period.
However, there are potential benefits of replacing heparinized saline flush with nonheparinized flush. These
benefits include elimination of risks associated with heparin and decreased potential for infection associated with
loss of sterility of flush solution when the heparin flush is
prepared, thereby providing safer therapy for the patient
and substantial financial savings for the hospital.9, 22, 36, 37
519

Y. Ueda et al.

The present study showed no statistically significant difference between the use of heparinized and
nonheparinized flush in maintaining peripheral catheter
patency for 42 hours (Table 1). The findings in the C
group actually suggest that 18-Ga catheters can maintain their patency without any additional flushes for
at least 24 hours after the catheters were placed and
1 of 2 catheters remained patent up to 42 hours. All
catheters in both HS and S groups flushed easily during each evaluation point through the end of the study
period. While there was no statistically significant difference noted between these 2 groups, there was a higher
incidence of catheter failure in aspirating blood back
from the S group than the HS group. However, all the
catheters that failed on blood aspiration were able to be
flushed easily. Furthermore, those catheters continued to
be functional until the end of the study period. A possible explanation for lack of aspiration followed by ease
of flushing is that there were small clots in the catheters
that inhibited blood withdrawal and those clots were
easily disrupted with the flush solution. It is also possible that factors other than coagulation, including inadequate pressure when holding off the cephalic vein, may
have contributed to the failure of blood aspiration from
the catheters. While it has been shown that peripheral
catheters can be used to collect serial blood samples from
dogs,38 withdrawing of blood from peripheral catheters
is not a common veterinary clinical practice. Based on
the results of this study, when peripheral catheters are
intended for serial blood collection, a heparinized flush
solution may be preferred to 0.9% sodium chloride.
The size of catheter (18-Ga) was chosen for this study
to maximize the ease of blood aspiration. Fluid flow
rates have been shown in dogs to increase exponentially
with increased catheter radius.39 The large catheter size
helped ensure optimal flow rate during aspiration. The
same size catheter was used for all subjects to maintain
uniformity. The effect of the catheter size on patency
was not evaluated, but smaller catheters would be expected to be more susceptible to thrombosis.40, 41 Additional studies are needed to evaluate if heparinized saline
solutions will be more effective in maintaining patency
of smaller diameter catheters in veterinary patients.
Polyurethane catheters were chosen for this study
since previous studies have shown that polyurethane
catheters permit longer patency with less risk
for phlebitis than teflon catheters.42, 43 Polyurethane
catheters have smoother microsurface, are thermoplastic and more hydrophilic, and tend to be much more
flexible than teflon. They also induce less platelet adherence in vitro and causes less thrombosis and inflammation in experimental animals.42 Silicone catheters may
cause fewer local complications although conflicting evidence is available.44, 45 It is possible that the use of a
520

Teflon catheter material may have changed the results

obtained in this study. Further studies evaluating the
role of catheter material and thrombosis in veterinary
patients should be considered.
The study period (42 h) was influenced by the availability of dogs. To the authors knowledge, there is no
study describing the average indwelling period for peripheral catheters in veterinary medicine. Anecdotally,
most catheters at the authors institution are in place for
an average of 36 hours before they are inadvertently removed or become no longer needed. At many veterinary
institutions, peripheral catheters are used almost immediately after placement for continuous infusion of IV
fluids and are infrequently left unused. These catheters
are usually not flushed until the continuous infusion of
fluids is discontinued since we believe it is much less
likely to be obstructed as long as the catheter is used
for the continuous infusion. However, in the authors institution, obstructions are noted in these peripheral IV
catheters while they are being used for the continuous
infusion of fluid. This brings into question the role of
heparinized flushes for catheters used for continuous
infusions of fluids. Human studies evaluating the role
of heparin in flushes have evaluated peripheral intermittent IV lines like evaluated in the current study.19, 46
Peripheral intermittent infusion devices are capped IV
catheters that are used to maintain fluid balance, deliver
intermittent medication, and provide access for emergency treatment. They are not routinely used on a continuous basis and might have an increased tendency for
venous obstructions than catheters used continuously.
To the authors knowledge, no reports have described
the efficacy and necessity of flushing catheters with continuous flow of fluids in human patients. More studies
are warranted in veterinary medicine to evaluate the role
of flushes in catheters with continuous flow of fluids.
Phlebitis is commonly associated with duration of
catheter patency because inflammatory stimulation at
the catheter site induces clot formation.12, 14 The presence
of phlebitis was determined based on the subjective findings of extravasation, erythema, pain, and swelling at the
catheter site as well as rectal temperature elevation. Our
study found no significant increase in the risk of phlebitis
in heparinized or nonheparinized saline groups for up
to 42 hours.
Only 1 concentration of heparinized saline (10 IU/mL)
was used in this study. The differences in heparin concentrations in flush solutions on maintaining patency
of peripheral IV catheters was not assessed. One study
evaluating arterial catheters demonstrated that using
0.25 IU/mL of heparin was equally as effective as
1 IU/mL,47 but there are no known studies comparing
heparin concentrations for use in peripheral IV catheters.
Human studies evaluating the efficacy of heparin in flush

C Veterinary Emergency and Critical Care Society 2013, doi: 10.1111/vec.12093

Heparinized saline vs. 0.9% sodium chloride

solutions have used a wide range of heparin concentrations varying from 0.1 to 10 IU/mL.40, 41, 47 We used 10
IU/mL of heparin in this study because we sought to
maximize the effect of heparin and ultimately demonstrate a difference, if any, between the HS and S groups.
There are several limitations in the present study.
The patency of the peripheral IV catheter was determined qualitatively by the investigator who flushed the
catheter. Both investigators have had years of experience flushing IV catheters, but there was no objective
measurement of catheter patency. The duration of the
current experiment was limited to 42 hours, and peripheral catheters are often maintained for longer periods in
clinical patients. Differences may exist between the HS
and S flush groups if the study could be performed for
a longer period. Future research utilizing a more objective measurement of peripheral IV catheter patency in a
larger population for a longer duration of time is warranted. It would also be important to assess the effect
of different catheter sizes and materials on the need for
heparinized flushes.
In conclusion, nonheparinized 0.9% sodium chloride
flushes were found to be as effective as 10 IU/mL heparinized saline flushes in maintaining patency of 18-Ga
peripheral IV catheters in dogs for up to 42 hours. For
peripheral catheters placed with the intention of performing serial blood draws, heparinized flushes may be
warranted.

Acknowledgments
The authors would like to thank Kyle Owens BS, LVT and
Brittany Scroggins for their assistance with the study.

Footnotes
a
b
c
d
e
f

Terumo Medical Corporation, Elkton, MD.

Hospira Inc., Lake Forest, IL.
3M Health Care, Neuss, Germany.
0.9% sodium chloride solution, Braum Medical Inc, Irvine, CA.
Heparin sodium injection, 1000 USP units/mL. APP Pharmaceuticals LLC,
Schaumburg, IL.
Statistical Analysis System software, SAS release version 9.2, Cary, NC.

References
1. Barrett PJ, Lester RL. Heparin versus saline flushing solutions in a
small community hospital. Hosp Pharm 1990; 25(2):115118.
2. Geritz MA, Hoare K, Jensen L. Saline versus heparin in intermittent
infuser patency maintenance. West J Nurs Res 1992; 14(2):131141.
3. Hamilton RA, Plis JM, Clay C, et al. Heparin sodium versus 0.9%
sodium chloride injection for maintaining patency of indwelling
intermittent infusion devices. Clin Pharm 1988; 7(6):439443.
4. Mathews KA, Brooks MJ, Valliant AE. A prospective study of intravenous catheter contamination. J Vet Emerg Crit Care 1996; 6(1):
3343.
5. Marsh-Ng ML, Burney DP, Garcia J. Surveillance of infections associated with intravenous catheters in dogs and cats in an intensive
care unit. J Am Anim Hosp Assoc 2007; 43(1):1320.

C Veterinary Emergency and Critical Care Society 2013, doi: 10.1111/vec.12093

6. Lobetti RG, Joubert KE, Picard J, et al. Bacterial colonization of

intravenous catheters in young dogs suspected to have parvoviral
enteritis. J Am Vet Med Assoc 2002; 220(9):13211324.
7. Fleeman LRJ. Intermittent heparinised saline flushes for maintaining indwelling peripheral and central intravenous catheters in diabetic dogs. Aust Vet Pract 2001; 31(3):126131.
8. Goode CJ, Titler M, Rakel B, et al. A meta-analysis of effects of
heparin flush and saline flush: quality and cost implications. Nurs
Res 1991; 40(6):324330.
9. Karen L. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in
children. J Emerg Nurs 1997; 23(4):306309.
10. Suojanen J, Brophy D, Nasser I. Thrombus on indwelling central
venous catheters: the histopathology of fibrin sheaths. Cardiovasc
Intervent Radiol 2000; 23(3):194197.
11. Talbott GA, Winters WD, Bratton SL, et al. A prospective study of
femoral catheter-related thrombosis in children. Arch Pediatr Adolesc Med 1995; 149(3):288291.
12. Tagalakis V, Kahn SR, Libman M, et al. The epidemiology of peripheral vein infusion thrombophlebitis: a critical review. Am J Med
2002; 113(2):146151.
13. Gorbet MB, Sefton MV. Biomaterial-associated thrombosis: roles of
coagulation factors, complement, platelets and leukocytes. Biomaterials 2004; 25(26):56815703.
14. Rabe C, Gramann T, Sons X, et al. Keeping central venous lines
open: a prospective comparison of heparin, vitamin C and sodium
chloride sealing solutions in medical patients. Intensive Care Med
2002; 28(8):11721176.
15. Heeger PS, Backstrom JT. Heparin flushes and thrombocytopenia.
Ann Intern Med 1986; 105(1):143.
16. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin
or unfractionated heparin. N Engl J Med 1995; 332(20):13301336.
17. ASHP therapeutic position statement on the institutional use of
0.9% sodium chloride injection to maintain patency of peripheral
indwelling intermittent infusion devices. Am J Health Syst Pharm
2006; 63(13):12731275.
18. Passannante A, Macik BG. The heparin flush syndrome: a cause of
iatrogenic hemorrhage. Am J Med Sci 1988; 296(1):7173.
19. Randolph AG, Cook DJ, Gonzales CA, et al. Benefit of heparin
in peripheral venous and arterial catheters: systematic review and
meta-analysis of randomised controlled trials. BMJ 1998; 316(7136):
969975.
20. Klenner AF, Fusch C, Rakow A, et al. Benefit and risk of heparin
for maintaining peripheral venous catheters in neonates: a placebocontrolled trial. J Pediatr 2003; 143(6):741745.
21. Tuten SH, Gueldner SH. Efficacy of sodium chloride versus dilute
heparin for maintenance of peripheral intermittent intravenous devices. Appl Nurs Res 1991; 4(2):6371.
22. Shoaf J, Oliver S. Efficacy of normal saline injection with and without
heparin for maintaining intermittent intravenous site. Appl Nurs
Res 1992; 5(1):912.
23. Meyer BA, Little CJ, Thorp JA, et al. Heparin versus normal saline
as a peripheral line flush in maintenance of intermittent intravenous
lines in obstetric patients. J Obstet Gynaecol 1995; 85(3):433436.
24. Diquelou A, Barbaste C, Gabaig AM, et al. Pharmacokinetics and
pharmacodynamics of a therapeutic dose of unfractionated heparin (200 U/kg) administered subcutaneously or intravenously to
healthy dogs. Vet Clin Pathol 2005; 34(3):237242.
25. Trepanier LA. Potential interactions between non-steroidal antiinflammatory drugs and other drugs. J Vet Emerg Crit Care 2005;
15(4):248253.
26. Appleton DJ, Rand JS, Priest J, et al. Determination of reference values for glucose tolerance, insulin tolerance, and insulin sensitivity
tests in clinically normal cats. Am J Vet Res 2001; 62(4):630636.
27. Dewey CW, Bailey KS, Boothe DM, et al. Pharmacokinetics of singledose intravenous levetiracetam administration in normal dogs. J Vet
Emerg Crit Care 2008; 18(2):153157.
28. Burkitt JM, Haskins SC, Aldrich J, et al. Effects of oral administration
of a commercial activated charcoal suspension on serum osmolality and lactate concentration in the dog. J Vet Intern Med 2005;
19(5):683686.

521

Y. Ueda et al.
29. White ML, Crawley J, Rennie EA, et al. Examining the effectiveness of 2 solutions used to flush capped pediatric
peripheral intravenous catheters. J Infus Nurs 2011; 34(4):260270.
30. Kadidal VV, Mayo DJ, Horne MK. Heparin-induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases. J Intern
Med 1999; 246(3):325329.
31. Ling E, Warkentin TE. Intraoperative heparin flushes and subsequent acute heparin-induced thrombocytopenia. J Anesth 1998;
89(6):15671569.
32. Brieger DB, Mak K-H, Kottke-Marchant K, et al. Heparin-induced
thrombocytopenia. J Am Coll Cardiol 1998; 31(7):14491459.
33. Alaraj A, Wallace A, Tesoro E, et al. Heparin induced thrombocytopenia: diagnosis and management. J Neurointerv Surg 2010;
2(4):371378.
34. Battistelli S, Genovese A, Gori T. Heparin-induced thrombocytopenia in surgical patients. Am J Surg 2010; 199(1):4351.
35. Ranze O, Ranze P, Magnani HN, Greinacher A. Heparin-induced
thrombocytopenia in paediatric patientsa review of the literature
and a new case treated with danaparoid sodium. Eur J Pediatr 1999;
158(15):S130S133.
36. Jordan L. Should saline solution be used to maintain heparin locks?
Focus Crit Care 1991; 18(2):144145, 147148, 150141.
37. Goode CJ, Titler M, Rakel B, et al. A meta-analysis of effects of
heparin flush and saline flush: quality and cost implications. Nurs
Res 1991; 40(6):324330.
38. Elliott KF, Fleeman LM, Rand JS. Using 20-gauge percutaneous peripheral catheters to reliably collect serial 4-mL blood samples from
conscious dogs. Aust Vet J 2010; 88(6):215221.

522

39. Fulton RB Jr, Hauptman JG. In vitro and in vivo rates of fluid flow
through catheters in peripheral veins of dogs. J Am Anim Hosp
Assoc 1991; 198(9):16221624.
40. Mudge B, Forcier D, Slattery MJ. Patency of 24-gauge peripheral
intermittent infusion devices: a comparison of heparin and saline
flush solutions. Pediatr Nurs 1998; 24(2):142145, 149.
41. Shah PS, Ng E, Sinha AK. Heparin for prolonging peripheral intravenous catheter use in neonates. Cochrane Database Syst Rev 2002;
(4):CD002774:127.
42. Maki DG, Ringer M. Risk factors for infusion-related phlebitis
with small peripheral venous catheters. Ann Intern Med 1991;
114(10):845853.
43. Karadag A, Gorgulu S. Effect of two different short peripheral catheter materials on phlebitis. J Intraven Nurs 2000; 23(3):
158166.
44. Rudin C, Nars PW. A comparative study of two different percutaneous venous catheters in newborn infants. Eur J Pediatr 1990; 150
(2):119124.
45. Everitt NJ, Madan M, Alexander DJ. et al. Fine bore silicone rubber and polyurethanecatheters for the delivery of complete intravenous nutrition via a peripheral vein. Clin Nutr 1993; 12(5):261
265.
46. Kotter RW. Heparin vs saline for intermittent intravenous
device maintenance in neonates. Neonatal Netw 1996; 15(6):
4347.
47. Bolgiano C, Subramaniam P, Montanari J, et al. The effect of two
concentrations of heparin on arterial catheter patency. Crit Care
Nurse 1990; 10(5):4757.


C Veterinary Emergency and Critical Care Society 2013, doi: 10.1111/vec.12093