In redoing our CVAD policy we are struggling to determine a safe amount of Heparin flush solution for our ports. We are aware of INS standards: flush a port with heparin 100 units per ml when de-accessing and for periodic access. We do not see any direction in INS for what volume of heparin to lock with.
The total volume of the Bard port we use is 1.5 ml. We feel that 3 ml heparin 100 units/mL is sufficient. However manufacturer's instructions advise to use "5ml of s heparininzed solution" after each infusion or medication, after each blood withdrawal, after each power dye injection, and when left dormant.
Do we build our policy around manufacturer's instructions?
We are especially concerned wtih the patient recieving intermittent infusions - that they could potentially recieve 500 units of heparin several times per day.
Is there a maximum number of accesses in a 24 hour period?
Thank you for any help you can give us on this.
The priming volume of each lumen of an uncut Bard PICC can be found here:
http://www.bardaccess.com/resources.php?category=ProductLiterature
look under you specific bard nursing PICC but from what I can see the maximum priming volume is 0.76 ml on the 17 gauge triple. 0.56 on 18g doubles. Remembering that is uncut. Bard literature states 1ml heparin should be sufficient also found here.
I am not sure what others do, but we pull off the previous heparin and discard. Even without that our hematologist said that is a tiny amount of heparin.
enjoy,
INS standards specifically states that the volume should be twice the internal volume of the entire system to be locked. As there are numerous variations of size and length, a specific volume cannot be stated that would be appropriate for all implanted ports. This is for de-accessing only. When the port is accessed and being used for intermittent infusion, then lock with heparin 10 units per mL , twice the internal volume. 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. Is that standard 45 under practice criteria "D"?
If it can be locked with 2 X internal volume - then 3 ml of heparin should be sufficient?
What about manufacturers instructions? Do INS standards trump manufacturers instructions?
Thanks very much - we appreciate this website and your advice.
Yes, #45, Practice Criteria D. Note that this has a level V, meaning that there is a very low level of evidence to support it. Flush volume is usually much more than 2X but lock volume is usually limited to 2X. For an implanted port, you must consider the volume of the catheter, the port reservoir and the access needle to ensure that the entire system has been locked. For some large reservoirs and catheter and needles with an extension set, this could mean more than 2 mLs so the need for at least 4 mLs to lock. Fill volume on most prefilled syringes is 5 mL, so that is the default volume for most. Usually the manufacturers are not very detailed and simply state to follow INS or CDC, etc. Do they have a different statement? If so, I would look at the date on their instructions and/or call their clinical dept to discuss the differences with a clinical person, not a sales person. 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