Hi all, we are having a debate concerning the use of heparin in central lines and occlusions. Everyone agrees that complete occlusions (fibrin buildup intraluminal) can be a direct effect of not using heparin (but not necessarily) but we are divided on whether or not heparin would affect fibrin buildup outside the catheter such as a fibrin tail. Since heparin is only found in the catheter, can it decrease fibrin buildup extraluminal? I appreciate your thoughts. Katie
Fibrin is going to accumulate on the internal catheter lumen with or without heparin. It is a simple matter of serum proteins attaching to the plastic and heparin will not alter this process. Complete lumen occlusion is most often due to many other factors that cause reflux of blood into the lumen and it is allowed to reside without being flushed back into the bloodstream. This includes syringe induced reflux, discoonection reflux from negative displacement needleless connectors without the correct flushing technique, empty infusion containers, and changes in intrathoracic venous pressure. So I do not agree that heparin reduces intraluminal fibrin. And heparin locking certainly has no impact on vein thrombosis. That is most often caused by improper tip location, catheter tip migration and dislodgment, and catheters that are too large for the vein. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
thanks Lynn for the response. The reason I am asking is that we recently moved to a saline-only needleless connector (tko by nexus). when I moved my IV team over we saw a significant reduction in the use of cathflo for partial occlusions. We have sustained this reduction for 16 months. When I moved 14 homecare offices over 3 months ago they have experienced a 40% increase in cathflo use due to predominately partial occlusions (inability to withdraw blood). We are trying to figure out why such a dramatic difference. IO have several nurses who swear up and down that they did not have problems with fibrin tails when they were flushing with heparin. Any suggestions?
TKO by Nexus Medical is not a stand alone product. It must have some other type of split septum or mechanical valve added to it. What is added to the TKO that you are using? I strongly suspect that this is related to flushing technique and/or tip location. I simply do not believe that the nurses can state that they had no problems with fibrin tails previously. There is simply no way for the nurse to make this assessment. All the nurse would know is that there is no blood return, but there is no way to tell if this is coming from a fibrin tail, a partial fibrin sheath or a complete fibrin sheath. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861