A labor and delivery nurse has complained about non patent IV sites and said at a conference she attended they stated heplock should be used to maintain patency of peripheral IV in pregnant women. Has anyone ever heard of any evidence to support this? My first response to her was are you routinely flushing with saline?
Some conditions that cause a higher risk of thrombosis include nephrotic syndrome, cancer, antiphospholipid antibody syndrome, pregnancy, oral contraceptive use, surgery, trauma, and severe infection. Pregnancy changes the plasma levels of many clotting factors. For example, fibrinogen can rise up to three times the normal value. Although the physiological anticoagulants protein C and antithrombin III remain constant, protein S decreases.Fibrinolysis is impaired owing to an increase in plasminogen activator inhibitor (PAI) and placenta-synthesized PAI 2. These changes are probably the physiological preparation for hemostasis during labor. A pregnant woman is in a state of hypercoagulability throughout her pregnancy. NS flushes can successfully be used to maintain lines, you just may have to increase the frequency of flushes and make sure they are using proper technique when disconnecting after the flush to prevent reflux of blood. I am also an AWHONN member and checked the site but have no supporting articles for the use of heparin vs. saline only flushes.
I would ask for evidence for that practice. We currently do not flush saline locks any differently for pregnant women. We are not having any significant difference in their patency.
I do understand that pregnant women are more hypercoaguble, but we find that more in the hyperemesis graviduram patients that need long term access. No research to back this, but this is the trend that we are seeing.
Gwen Irwin
Austin, Texas