Aloha! When continuous fluids or medications are infusing 24 hours per day via a CVC, what is a recommendation for flushing non-tunneled central catheters and checking for blood return with aspiration. In the ICU this is often the case. All lumens are in use and to break a connection to flush and check for a blood return seems less than optimal and with potential for contamination.
What is your thinking on this specific case and what are your ICU nurses actually doing? Flush with tubing changes and injection cap changes? Flush whenever the med/fluid bag is changed? What (based on expert opinion - level 5) evidence is there for a recommendation? Our ICU nurses ask this question when we recommend flushing and blood return q shift.
Thanks for your thoughts.
Scott Gilbert
No one has ever suggested or recommended that breaking a connection on continuous fluids to assess for a blood return was necessary. Far from it!! No connection should ever be opened for this purpose. You can easily check for a blood return by simply attaching a saline filled syringe to an injection site on the IV administration set, aspirate and inject the saline to assess for catheter patency. This should be done before each and every intermittent med infusion. The unaswered question is how frequently this catheter functionality assessment is required when there is continuous fluids infusing. For ICU this means lots of vasopressors, many of which are vesicants. So I would check these lines at least once per 8 hour shift, but this is my opinion and not an evidence based recommendation. Of course, you would need to consider what is infusing and any bolus effect that this assessment may have on the infusing medication. I strongly believe that a periodic assessment for a positive blood return is one critical component of catheter assessment. 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