From the Guidelines
No, heparin is not recommended for clearing an occluded Peripherally Inserted Central Catheter (PICC) line.
Heparin Use in PICC Lines
- The use of heparin in PICC lines is generally not recommended for preventing thrombotic occlusion in children due to a lack of proven benefit 1.
- However, for PICC lines that are being accessed intermittently, flushing with 5-10 U/mL heparinized saline 1-2 times weekly may help maintain patency 1.
- The routine use of heparin has been shown to be effective in preventing PICC occlusion in newborns, but its routine use cannot be recommended due to potential risks 1.
Alternatives for Clearing Occluded PICC Lines
- Recombinant tissue plasminogen activator or urokinase is recommended for unblocking a catheter 1.
- A systematic review found that urokinase appears to be more effective than placebo in restoring patency in occluded catheters 1.
- Another study suggested that fibrinolytic drugs, such as urokinase and alteplase, can be used to treat acute catheter occlusion likely caused by blood clotting 1.
Important Considerations
- The use of heparin in PICC lines should be carefully considered, taking into account the potential risks and benefits, as well as alternative methods for maintaining patency and clearing occlusions 1.
- Adequate flushing with saline when the infusion of PN is completed can help prevent catheter occlusion 1.
The FDA Drug Labels for heparin (IV) do not address this question.
From the Research
Heparin Use in Clearing Occluded PICC Lines
- The use of heparin in clearing occluded Peripherally Inserted Central Catheter (PICC) lines has been studied in various research papers 2, 3, 4, 5, 6.
- A study published in 2010 found that heparin flush (10 units/mL) decreases thrombotic occlusions of central venous access devices, resulting in decreased alteplase use and fewer PICC line replacements 2.
- Another study published in 2017 found that the use of heparin as a continuous infusion significantly prolonged the duration of patency, reduced rates of infusion failure, and occlusion in peripheral intravenous catheters 3.
- An in vitro study published in 2015 found that the use of low molecular weight heparin at a concentration of 50IU/mL was more effective in restoring the permeability of neonatal PICCs occluded in vitro by a clot 4.
- However, a systematic review published in 2016 found that it remains unclear whether heparin is necessary for CVC maintenance, and more well-designed studies are required to understand this question 5.
- A recent overview of systematic reviews published in 2024 found that there was no evidence that heparin was more effective than normal saline in reducing complications such as occlusion, catheter-related infections, and thrombosis in central venous catheters in adults 6.
Key Findings
- Heparin may be effective in preventing thrombotic occlusions in central venous access devices 2.
- Heparin may be effective in restoring the permeability of occluded PICC lines, particularly at higher concentrations 4.
- The use of heparin versus normal saline in locking central venous catheters in adults does not show a significant difference in reducing catheter occlusion 6.
- More research is needed to determine the effectiveness of heparin in maintaining PICC line patency and preventing occlusions 5.