Background: Arterial catheters are widely used in critically ill patients for continuous blood pressure monitoring and frequent blood sampling.Maintaining catheter patency is essential to avoid occlusion, inaccurate readings, and unnecessary reinsertion.Evidence regarding the superiority of heparinised saline over normal saline remains inconsistent.The aim of this systematic review and meta-analysis was to compare the effectiveness and safety of heparinised saline versus normal saline flushing solutions for maintaining arterial catheter patency in intensive care units (ICUs).Methods: A comprehensive search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed up to June 2025.Only randomised controlled trials comparing heparinised saline and normal saline for continuous arterial catheter flushing in ICU patients were included.The primary outcome was catheter occlusion; secondary outcomes were catheter patency duration, platelet count, and activated partial thromboplastin time.Risk of bias was assessed using the Risk of Bias version 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: Sixteen randomised controlled trials, including 6385 patients, were included.Pooled analysis of 13 trials showed that heparinised saline was associated with a lower risk of arterial catheter occlusion than normal saline (risk ratio: 0.64; 95% confidence interval: 0.50-0.84;I 2 = 20.6%).However, prediction intervals crossed unity, and meta-regression demonstrated attenuation of effect in more recent studies.Certainty of evidence was rated low.Heparinised saline was associated with a modest prolongation of catheter patency duration (+12.5 h; 95% confidence interval: 1.43-23.50),while no significant differences were observed for platelet count or activated partial thromboplastin time.Safety outcomes were inconsistently reported, and included trials were not powered to detect rare adverse events.Conclusions: Heparinised saline was associated with reduced arterial catheter occlusion in pooled analyses, but this effect diminished over the years and may not translate to contemporary ICU practice.Further contemporary, well-designed trials are needed to clarify whether selected high-risk populations may derive meaningful benefit.
Imbrìaco et al. (Mon,) studied this question.