Abstract TP371: Stroke Center Heparin Flush Use in Transfemoral Angiography Survey
Background and Purpose: The drug concentration of heparinized saline used for transfemoral catheter angiography flush during different types of cerebral endovascular interventions varies among operators and centers worldwide. While heparin use is recommended during cerebral angiograms to minimize the risk of thromboembolic events, there is a paucity of information regarding protocols for administration of heparinized saline. Higher concentrations of heparinized saline may benefit patients undergoing elective intracranial aneurysm embolization by decreasing the risk of thromboembolism. However, it may place patients undergoing revascularization procedures for acute ischemic stroke at higher risk of symptomatic intracerebral hemorrhage, particularly if they received intravenous tissue plasminogen activator immediately prior. Methods: After obtaining permission from the Association for Radiologic and Imaging Nursing (ARIN) Board of Directors, a survey was electronically distributed by ARIN to its members via the ARIN List Serve. Response to the survey was identified as consent to participate. Subjects were asked to participate if they were currently involved in the management of patients undergoing cerebral angiography with a variety of interventions. Results: The most frequently used concentration of heparinized saline flush was 2 units/ml (32.8%-34.8% range, depending on endovascular intervention), and the least frequently utilized concentrations were 3 units/ml and higher than 5 units/ml (4.3%- 5.7% range, depending on endovascular intervention). Mixing and labeling bags with heparinized saline flush was noted to be the responsibility of interventional radiology registered nurse (39%, n= 46), pharmacy (26.3%, n= 31), or the angiography technologist (8.5%, n= 10). Conclusions: There are no standard protocols across stroke centers identifying optimal heparinized saline flush solution concentration, preparation and documentation. Replication of this survey among members of the American Society of Neuroradiology is recommended to validate the findings from the current study. If confirmed, a consensus on safety of heparinized saline flush use during neuroradiology interventions is advised.