Hello. Im going round and round. I have done what I thought was good research; however have not located anyting to substantiate flushing CVADs with NSS vs Heparin. This includes 2016 INS guidelines. There is no finite standard of care, many calling for more RCT's to support.
Im asking if this is anyone's practice, and what evidince do you you to support? Thank you
There are numerous studies both including in the INS SOP and more since then that found NS and heparin for locking CVADs to have equivalent outcomes. You will not find a study stating that one is superior to the other. Thus the INS standard states that either are acceptable. NS works equally as well as heparin lock solution, therefore why take the risk of heparin.
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 so very much for your reply. May I also inquire as to the "lock" solution?
Bobbi Price MSN, RN
Not sure I understand whay you are asking. Normal saline or heparin lock solutions are the only regular solutions used to lock any VAD. Most facilities have now switched to normal saline for both flushing and locking. See INS SOP Glossary for definitions of those terms. There are many alternative antimicrobial lock solutions however there are none that have been cleared for market by the FDA. These alternative lock solutions are on the market in other countries and there are numerous studies showing outcomes with their use. But they all have pros and cons. These alternative solutions must be made by a compounding pharmacy.
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
What you are assumming is correct. I was just stating that I have seem read (suggestive research) and a few anecdotal statements noting to "flush" with NSS and "lock" with Heparin Saline solution. Thanks again.
Bobbi Price MSN, RN
NS for flushing and heparin for locking is the traditional practice. But a very large amount of evidence now shows that NS can be used for both flushing and locking.
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
I did research on this also a couple of years ago. I wonder why it is so slow to get this information out there and to change practice? I would much rather use NS than heparin.
Good question. Guess it is hard to believe that an anticoagulant is not really needed.
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
Does anyone have a Policy / CVAD maintainance table they are willing to share for Normals Saline Flush/Lock only? Thank you in advance!
Bobbi Price MSN, RN