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Heparin flush protocols

Good grief!  I'm a relative newcomer to the IV therapy world, having been in a PRN capacity for a little over a year and recently taking a fulltime position with the IV Team at my facility.

We are trying to update our policies and protocols and it seems there is as much confusion in the community as I'm feeling right now.  I've been searching through numerous journals and websites trying to find out what the current consensus is on heparin flushes for PICC lines.  Some say yes, some say no, depending on what kind of line is being used or what kind of cap.  There's also a lot of discrepancy as to the amount of heparin and the frequency.

Our current policy (for adults ... pedi/neonatal is a whole different ballgame) states to flush with NS every 8 hours.  But the preprinted order states to flush with 10 cc NS followed with 1 ml of heparin 100 units/ml every 12 hours or after meds -- if it is a locked lumen.  Lumens in use do not get flushed.  So our orders and policy are not matching up.  We need to rectify that and I was trying to get the right info to take back to the committees responsible for approving these changes.  I don't work for any company, but will state we use BARD Power PICCs and recently added the Biopatch and V-link to our line care program.

What is the flush protocol at your institutions?  Would you mind sharing that info?  Also any references I could back up my research with would be a great help. 


At this point, your

At this point, your questions are answered by the type of catheter and needleless connector you are using. The PowerPICC is an open-ended catheter without any integral valves. Those are flushed with SASH - saline, administer the med, saline, heparin. V-link is a negative displacement connector, also requiring SASH. You can reduce the amount of heparin to 10 units per mL except for the de-accessing of an implanted port. Lumens receiving a continuous infusion do not require routine flushing. Those would only be flushed if there was a problem such as pump beeping a downstream occlusion, blood backed up, etc. Each catheter use requires an assessment of how that catheter is functioning. This is done with 10 mls saline in a 10 ml syringe. You should rule out resistance and get a positive blood return. Give the med, then flush as again with 10 of saline, then 3 mL of heparin 10 units per mL. If intermittent meds are at least every 12 hours, there is really no need to flush in between those meds. If only every 24 hours, you might need an additional flush at the 12 hour interval, however this is not evidence based.

You should obtain the new Flushing Protocol cards from INS to get some of these details. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thank you.  I will do

Thank you.  I will do that.


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