Abstract: Background: Infusion Therapy Standards of Practice published in 2021 did not provide a clear recommendation on how to choose between normal saline and heparin saline as the locking solution for neonates and children, however, Clinical Practice Guideline on Infusion Therapy in Children recommended using heparin solution. Objective: To compare the effects of heparin saline (HS) and 0.9% normal saline (NS) solution as the locking solution of a peripheral intravenous catheter (PIVC) on different pediatric populations. Design: Systematic review and metaanalysis of RCTs. Methods: Hospitalized pediatric patients who need PIVC were divided into the intervention group using HS and the control group using NS. Literature was searched in English databases of Ovid MEDLINE, PubMed, Cochrane Library, and Chinese database of SinoMed from April 1, 2014 to November 23, 2021 for there have been two articles of systematic review and metaanalysis on this topic published in 2005 and 2013. RoB 2 was used to evaluate the risk of bias in the included studies. Main outcome measures: PIVC duration and the related complications. Results: A total of 21 RCTs were included in the analysis. The duration of PIVC in HS group was 8.62 h longer than that in NS group (95%Cl: 2.9814.26, I2=91%, random effects model), and the difference was statistically significant. After removal of four literature about neonates because of greater heterogeneity, the metaanalysis of other eight literature showed that PIVC duration in neonates of HS group was increased by 6.04 h (95%Cl: 4.177.91, I2=56%, random effects model), and the difference was statistically significant. The pooled results of five studies for both neonates and children showed that the PIVC duration of HS group was prolonged by 6.22 h(95%Cl: 2.729.73, I2=20%, random effects model), and the difference was statistically significant. For the population of children, the pooled results of three studies indicated that the PIVC duration was prolonged by 6.94 h(95%Cl: -1.2715.15, I2=27%, fixed effects model ) in HS group, and there was no statistically significant difference. According to the pooled results of 18 studies, the incidence of complications decreased by 17% (RR=0.83, 95%Cl: 0.710.97, I2=19.5%, fixed effects model) in HS group compared with that of NS group, and the difference was statistically significant. The incidence of complications in neonates decreased by 25% in HS group(RR =0.75, 95%Cl: 0.620.91, I2=0%, fixed effects model) according to the pooled analysis of 9 studies, and the difference was statistically significant. There was no significant difference in reducing the incidence of complications between the two groups for children (4 studies) and the population of both newborns and children (5 studies). Conclusion: Locking PIVC by heparin saline is desirable for the neonatal population in terms of duration and complication incidence. Whether it is beneficial to the whole pediatric population still needs to be further explored.

Key words: Peripheral intravenous catheter, Normal saline solution, Heparin solution, Duration, Complications