Efficacy of 1.4 percent sodium citrate in maintaining arterial catheter patency in patients in a medical ICU

Abstract

Purpose: The primary purpose of this study was to compare the efficacy of 1.4 percent sodium citrate with heparin, 4 U/ml, for maintaining radial artery catheter patency in patients in the medical ICU.

Patients and methods: Patients in the medical ICU (n = 40) were randomized to either a 1.4 percent sodium citrate or heparin 4 U/ml arterial line flush solution in a double-blind, parallel fashion. The flush solutions were continuously infused at approximately 3 ml/h over a maximum of 96 h. Catheter survival rates were compared using Kaplan-Meier survival curves. The frequency of catheter malfunctions and corrective manipulations were recorded and compared. Coagulation status (APTT, PT) and ionized calcium values were monitored to evaluate the systemic effects of sodium citrate.

Results: Ninety-four percent of catheters flushed with sodium citrate were functional at 48 h compared with 88 percent for heparin (p > 0.05). At 96 h, 80 percent vs 88 percent of the catheters were functional in the citrate and heparin groups, respectively (p > 0.05). Frequency of catheter malfunctions did not differ between the two groups. No systemic effects of sodium citrate were observed.

Conclusion: Arterial catheter flush solutions containing sodium citrate (1.4 percent) are an effective and safe alternative to heparin in patients requiring peripheral arterial catheterization.