What is the recommendation from INS for flushing an implanted port when there is an access neddle in place and intermittent IV therapy is given?Is it acceptable to flush with saline only and only lock with a heparin solution upon de-accessing the port? Thank you for the help. I have looked through the INS guidelines and don't really see this addressed.
Celia
The standard on flushing and locking applies. Manage an implanted port in the same manner as all other CVADs when it is accessed. 2011 Standards do state to lock with heparin 100 units per mL when deaccessed but more recent research says that heparin or saline is acceptable. 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
We typically flush with saline and lock with heparin 10units/mL when an accessed port is used intermittently more than once a day. Currently we are looking at changing the procedure to say flush and lock with saline and I am looking for evidence recommending this. Thanks again, Celia
I know of two recent articles and I am eager to see if they make it in to the next INS SOPs. ;-) Lynn
1. Bertoglio, S., Solari, N., Meszaros, P., Vassallo, F., Bonvento, M., Pastorino, S., & Bruzzi, P. (2012). Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients. "Cancer Nursing," 35, 4, E35-E42. doi: 10.1097/NCC.0b013e31823312b1
2. Goosens, G. A., Jerome, M., Janssens, C., Peetermans, W. E., Fieuws, S., Moons, P,...Stas, M. (2013). Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomized, non-inferiorty, open trial. "Annals of Oncology," 24, 1892-1899. doi10.1093/annonc/mdt114
Good luck!
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Part of the answer may depend on what type of connector cap/injection cap you are using. If it is neutral displacement, our experience is that saline only is fine while patient is hospitalized. We only use heparin at deaccess.
I can confirm that those and several more are in the INS 2016 Standards. 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
Thank you, all. This is very helpful.
Celia