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The ‘heparin lock’: cause for iatrogenic coagulopathy

Published online by Cambridge University Press:  23 December 2005

M. Vorweg ,
E. Monaca ,
M. Doehn  and
F. Wappler
M. Vorweg
Affiliation:
University of Witten/Herdecke, Department of Anesthesiology, Hospital Cologne-Merheim, Köln, Germany
E. Monaca
Affiliation:
University of Witten/Herdecke, Department of Anesthesiology, Hospital Cologne-Merheim, Köln, Germany
M. Doehn
Affiliation:
University of Witten/Herdecke, Department of Anesthesiology, Hospital Cologne-Merheim, Köln, Germany
F. Wappler
Affiliation:
University of Witten/Herdecke, Department of Anesthesiology, Hospital Cologne-Merheim, Köln, Germany
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Extract

Summary

Background and objective: The reasons for coagulopathy may be multiple and the identification of the underlying cause is often difficult. Recently, we identified two patients showing characteristics of heparin overdose during surgery. We hypothesised that filling a Shaldon dialysis catheter with heparin prior to closure, so-called heparin lock, might have triggered this coagulation disorder. Therefore, the aim of this in vitro study was to show whether this procedure can lead to an iatrogenic administration of heparin. Methods: A Shaldon catheter (GamCath®; Joka Kathetertechnik, Hechingen, Germany) was hung up in a container filled with NaCl solution 0.9% 5 mL and a heparin lock was simulated. Instead of using heparin solution we injected 1 mL of a KCl solution (1 mol L−1) into the Shaldon catheter, because the measurement of the potassium concentration is faster and more reliable than that of heparin. Ten measurements were taken after fast (0.5 s) and slow (3 s) injection speeds. Results: Although the catheter volume is specified as 1.07 mL, an amount up to 0.51 mL KCl solution on average was detectable in the solution after locking the catheter with 1 mL KCl solution. Conclusions: Following a heparin lock a considerable amount of the injected solution is accidentally administered to the patient. Only 49.1% of the injected volume may remain in the Shaldon catheter. This could lead to an increased risk of coagulopathy.

Keywords

HEPARINTHROMBOELASTOGRAPHYRENAL REPLACEMENT THERAPYBLOOD COAGULATION DISORDERS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 50 - 53
Copyright
© 2006 European Society of Anaesthesiology

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