Prophylactic topical heparin can prevent or postpone intravenous cannula induced superficial thrombophlebitis

Abstract

Intravenous cannulation is a cornerstone of today's medical practice. Maintaining a single indwelling intravenous (IV) cannula for long duration is limited by the development of superficial thrombophlebitis (ST). It is a self limiting inflammation and thrombosis of superficial veins. ST presents with fever, pain, erythema, tenderness and cord like swelling. The incidence of ST is high and usually occurs within 72h of IV cannula insertion. The current standard medical therapy for ST is topical heparin application for 7 days. Heparin acts by preventing coagulation rather than lysing a formed clot. So, if topical heparin is started prophylactically even before ST sets in, i.e. from day 1 of IV cannula insertion it can prevent or postpone ST more effectively. It increases the indwelling time of a single IV cannula and can be very useful in high risk groups requiring IV cannulation like patients receiving cancer chemotherapy, ICU patients and infants. It decreases the need for recurrent cannulations and associated morbidity thereby improving patient compliance. It also prevents extended hospital stay due to ST and related complications. High incidence of ST justifies the use of prophylactic topical heparin with all IV cannulations. Prophylaxis will be better than treatment in managing patients with IV cannulas.