How are you all handling getting a heparin flush order for ports? Do you get a separate physician's order each time the patient is admitted...or an initial and continuing order for series patients? Or do you have a standing order or protocol that can be initiated without contacting the physician?
I'm in Oregon and would be especially interested in response from surrounding states...or other hospitals in Oregon.
Thanks
We created standardized central line order sheets for all central lines - peds/adult inpatient/outpatient, and put a chart on each order sheet that lists the different kinds of catheters/devices so the MDs could circle. Each type has the specific flush listed with it - makes it simple for the physicians, and standardizes the process. That way the flushes make it on to the medication administration record, and the nurses must sign that they've done it.
Any time a patient gets an IV RN PICC or a line placed by an MD, this order form is to be completed.
If anyone wants to see them, I could have Sarah post in the downloads.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Do most teams/hospitals use heparin to flush the medi-port/porta-cath (implanted ports)? Or is this practice changing to saline for these specific lines?
Carole
Are you asking about flush/lock when the port is accessed or at the time of access removal? When accessed, the use of heparin totally depends upon the type of needleless connector that you have attached and its instructions regarding saline only flushes.
There are at least 2 brands of ports now with integral valves that state saline only.
For locking upon access removal, this is still primarily being done with heparin unless the patient is known to have HIT. In that case, you may be forced to substitute alteplase, citrate, or saline only, however there are no studies using these alternative solutions for implanted ports yet.
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
T. Nauman RN, CRNI IV Educator SHMC Eugene, OR
We flush with heparin when de-accessing the port...rarely at other times. We use heparin with all ports because much of the time neither we nor the patient knows if their port has a valve requiring saline only.
I guess I'm asking if most hospitals have a standing order or protocol for port care, or if the physician must specifically order heparin each time the patient is admitted.
Thanks for your responses.
Tanya
T. Nauman RN, CRNI
Most hospitals have a policy and procedure that has been through all the applicable committees, therefore a physician's order is not required for each patient unless there is the need to deviate from that policy such as HIT diagnosis. To ensure that all catheters get flushed appropriately and that all supplies are sent from the pharmacy, many hospitals have created nursing order forms. I have never worked in a hospital where we required any type of physician order for flushing any type of catheter. It was established in p&p. This is not the case with home care where those pharmacies operate under the rules applicable for retail drug outlets where a specific patient order is required.
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
Yes, I meant as a locking solution when de-accessing or with the intermittent use of the implanted port.
Thank you for your timely response.
We've been through the nursing order idea for flushes several times. We need a physician's order to place flushing on the MAR for nurses to sign, and the MDs are happy to complete the forms (forms designed by RNs).
After a long and comprehensive multidisciplinary quality project (including infection control, risk management, quality, safety, education and research, med/pharmacy, surgical and medical physician administration committees- on and on) to improve central line care and education, our group learned from our data that it was very important to ensure it was getting done properly, with minimal variation throughout the facility. Having standardized order forms help to reduce variation, especially when dealing with multiple clinics.
We've had it in the p&p for years, have included in annual mandatories and regular reinforcement, etc. etc. We're a large teaching facility with a very large staff that includes inpatients and outpatients in many different kinds of clinics, residents (MDs) rotating in and out, many different vendors and home health agencies.....it wasn't enough. Plus - most nurses know how to access policies, but policies aren't much help if they don't have time to access the information because they're so busy providing care. This way - it's right in front of them, easy to read, for every patient with a central line, every day (in the MAR, and eventually in the EHR or electronic health record).
Mari Cordes, BS RN
Fletcher Allen Health Care, Burlington VT
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center