Timing for Holding Heparin Infusion Before Right Heart Catheterization
Hold the heparin infusion 2 hours before the 9:00 am Right Heart Catheterization, meaning stop the infusion at 7:00 am. 1
Rationale for the 2-Hour Hold Time
For coronary angioplasty and catheterization procedures, the American Heart Association recommends stopping heparin infusion 2 hours before accessing the site. 2 This timing allows for adequate clearance of systemic heparin while minimizing thrombotic risk during the brief interruption.
Right heart catheterization involves vascular access and catheter manipulation, similar to coronary procedures, requiring sufficient clearance of heparin to reduce bleeding risk at the access site while maintaining patient safety. 1
The 2-hour interval is substantially longer than the 15-20 minute hold recommended for simple blood draws or accessing the same site for laboratory sampling, reflecting the more invasive nature of catheterization procedures. 2
Key Procedural Considerations
Heparin will typically be re-administered during the RHCath procedure itself if clinically indicated, as unfractionated heparin is commonly given during catheterization procedures to prevent thromboembolic complications. 1, 3
For diagnostic catheterization procedures, heparin is usually administered just before or immediately after arterial access is obtained, with typical bolus doses of 2000-5000 units IV. 3
The activated clotting time (ACT) should be monitored during the procedure, with target ACT levels of 200-300 seconds for standard diagnostic procedures. 1, 3
Special Circumstances That May Modify Timing
Patients with renal dysfunction may require a longer hold time (up to 30 minutes additional) due to prolonged heparin effect, though this is more relevant for minor procedures than for catheterization where a 2-hour hold is already standard. 2
For patients at very high thrombotic risk (mechanical heart valves, recent stroke, or active thrombosis), the interruption should be kept as brief as possible, and the procedural team should be notified to expedite the procedure. 1
If the patient is on both heparin and antiplatelet agents, the 2-hour hold time remains appropriate, but increased vigilance for bleeding complications is warranted. 2
Common Pitfalls to Avoid
Inadequate hold time increases bleeding risk at the access site and may complicate sheath insertion, while excessive hold time may compromise therapeutic anticoagulation in high-risk patients. 2
Do not flush the heparin line with a bolus before disconnecting - simply clamp and stop the infusion to avoid inadvertent bolus administration. 2
After the procedure is completed, heparin can be restarted without a bolus more than 4 hours after peripheral vessel sheath removal, according to standard protocols. 1
Document the exact time the heparin infusion was stopped and communicate this clearly to the catheterization team. 2