Central line flush; patency (intermittent doses): Limited data available: Various recommendations exist for intermittent flushes of heparin used to maintain patency of single and double lumen central catheters; dose of heparin flush used should not approach therapeutic unit per kg dose; refer to institution specific protocols. In neonates, the 10 units/mL concentration is used with frequency and volume of flushing determined by the type of catheter; capped polyvinyl chloride catheters and peripheral heparin locks require flushing more frequently (eg, every 6 to 8 hours). Volume of heparin flush is usually similar to volume of catheter (or slightly greater) or may be standardized according to specific NICU policy (eg, 0.5 to 1 mL/flush). Additional flushes should be given when stagnant blood is observed in catheter, after catheter is used for drug or blood administration, and after blood withdrawal from catheter (Cloherty 2017).

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0.5 units/kg/hour is used for maintaining patency of central vascular catheters.

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Umbilical artery catheter (UAC): Intra-arterial (via UAC): Continuous infusion of heparin at a final concentration of 0.25 to 1 unit/mL; total heparin dose of 25 to 200 units/kg/day to maintain patency (ACCP [Monagle 2012]).

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• Kotter RW: Heparin vs saline for intermittent intravenous device maintenance in neonates. Neonat Network1996;15:43-47.
• Moclair A, Bates I: The efficacy of heparin in maintaining peripheral infusions in neonates. Eur J Pediatr1995;154:567-70.
• O’Grady NP, Alexander M, Burns, LA, et al: Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e17-e18.
• Paisley MK, Stamper M, Brown J, et al: The use of heparin and normal saline flushes in neonatal intravenous catheters. Pediatr Nurs1997;23:521-27.