We have been trialing saline-only flushing of CVC's at our hospital since April...with mixed results. The biggest arguments I've been receiving are from our local college nursing school instructors who point to INS standard 50, Flushing, Practice Criteria: F. Flushing with a heparin flush solution to ensure and maintain patency of an intermittently used central vascular access device should be performed at established intervals.
 These instructors say that even if our policy and procedure state to flush with saline only, it would be indefensible in court since INS standards say to use heparin solution. What do you experts out there say?
I'm concerned about going outside not only INS standards but also the manufacturers Directions for use. I know some reps are telling clinicians that saline only is fine with a certian end caps but the evidence I've seen is anecdotal. I've seen it work work well with the Boston Scientific valve but am concerned that the market is trying to jump ahead of evidence. Without protections that research would provide it seems premature to not use heparin for flushes.
I'll be very interested to see the INS working group will develop on this question.
Ann E. Briggs, RN, BSBA, CRNI
Quality Improvement Coordinator
Largo Medical Center
Ann E. Briggs, RN, BSBA, CRNI
Quality Improvement Coordinator
Largo Medical Center
Largo, FL
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
Heparin is 100 years old and the FDA did not exist when it was invented. Heprain was grandfathered in. It was not used on patients until the 50's. It is made of pig or cattle lung tissue. The half life is less than one hour. There are studies over the years to question its effectiveness to reduce clotting. Not sure if it ever worked. By the way it is not fibrin specific and all it does it attempt to reduce clot formation to add on to an existing clot. I am doing lots of heparin research lately.
Will the use of heparin or saline only make a difference for CVC's. At this point there is no confirmed opinion on open ended lines as there is no large prospective, randomized blinded studies. I would not expect to see anyone do this research as heparin cost pennies to administer as well as saline. I think the bigger question we will have over the next three years is should we even use heparin or is it an outdated drug. With the growing awareness of HIT and the new JACHO guideliens for 2008 on usage of heparin for DVT prophylaxis as a NO I think we will see changes in heparin use. New recommendations indicate to use LMWH instead as it lowers the risk of HIT. ASHP published a paper on getting rid of heparin in all peripherals. It is a matter of time a few years that we see the elimination in central lines as well and go saline only.
To add this thought if you utilized a product that has been approved by the FDA for saline only such as a valved catheter, port, or needle-less system than you can stop using heparin and stop exposing the patient needlessly to a drug that may or may not work. No studies to indicate it works in the last decade at least. there are at least 3-4 needle-less systems that have this indication.
The future holds no heparin - therefore no HIT risk
Kathy Kokotis
Kathy Kokotis
Bard Access Systems
Kathy Kokotis
Bard Access Systems