I am reviewing some of our hospital catheter flush policies. We are routinely flushing all lines every 8 hours with saline whether they are infusing or not, unless there is a concentrated drip running. We have gone to saline only flushes with the exception of the ports, which call for heparin 100 units/ml 5ml to lock.  My questions are:
1) Is anyone routinely flushing infusing lines every 8 hours or at all?
2)Â Is anyone flushing accessed but non-infusing heparin locked ports with heparin 3 times a day?Â
I find nothing to base any of this on and would like to get some concensus. Thanks in advance for your time. Janet Brown-Wise
PLEASE, when you are flushing an infusing line, you are bolusing the patient with whatever medication the patient is getting. Calculate the dose of medication that you pushing into the patient in an average 5ml - volume of the tubing!!!!
Think about bolusing with critical drugs like dupamin, morphine, inocor.
Also when you flush a line x3 per day with 100onits/mlx 5ml, the patient is getting a daily dose of 1500Units heparin /day.
Just a comment regarding the heparin flushes to chest Ports. It does not matter what the DAILY OVERALL DOSE IS, what matter is the TIME it is given. Half life for Heparin is 45 minutes. (We routinely insert PICC in people on high dose Heparin drips, hold the drip for 45 min, insert the line, confirm tip placement, then resume Heparin drip).
YES IT MATTERS WHAT THE DAILY DOSE OF HEPARIN IS IS!!!!!!!!!!!!! DOBUTAMIN HALF LIFE IS ONLY 3 MINUTS. WHAT ABOUT THE DEATHS DUE TO HEPARIN OVER DOSE? IT DOES MATTERS. THERE IS A CONDITION CALLED HEPARIN INDUCED THROBOCYTOPENIA TOO. The heparin action does not go away in 45 minutes.
I insert an average of 5 PICCs a day. We donot hold the heparin drip routinly.
I AM also talking about bolusing the medication that is infusing. MEANS when you flush a line you are pushing the medication that is in the line.
There is no need to routinely flush any catheter that is being used for continuous infusion of any fluid or medication.
Heparin should be the lowest concentration. HIT is definitely not related to the dose as it happens with any heparin at all, regardless of the dose, even smallest concentration of heparin flush solution.
There is no science to support the frequency of flushing any intermittent catheter. Most common is at least daily in home care, every 8 to 12 hours in the hospital, and every visit in ambulatory care. This is not based on clinical evidence, but what works for each setting.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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