Good morning:
Our policy states that we must flush our un-used or intermittently used CVADs every 8 hours with 2 - 3Â ml of Heparin Flush.
We are currently using Heparin Flush Solution 100u/ml.
Let's say the patient receives antibiotic treatment and pain management via that intermittently used lumen. Let's say, antibiotics every 6 and 8 hours.
INS papers say that a lumen should be flushed with 1 to 2 times the amount of solution held by a lumen.Â
Most lumens will hold about 1ml or slightly more.
Some of our nurses have asked if they are putting too much Heparin in the patients by following the policy.
We sort of agree with them but until the policy is changed and we ask the hospital to switch to a 10 units/ml concentration, what should we teach the nursing staff that cares for these lines?
One of the suggestions I gave was to withdraw 1 to 2 ml of blood when checking the line for patency before infusing medications, thus removing a small amount of Heparin flush from the line and not instilling it in the patient, but, realistically, the patient has already gotten at least 150 units more than needed the last time the line was flushed. Multiply that amount by 6 (the numbers of times the line is flushed with Heparin Flush if on antibiotics Q 6 and 8) and the patient has received 1200 (to 1800) units of Heparin.
The new Flushing Guidelines by INS recommend 10 - 100 units/ml when flushing adult CVADs, but I don't recall reading a STRONG recommendation.
Does anyone know of any article I could get my hands on to prepare for the next Policy and Procedure review that would be of help in resolving this problem?
I thank you in advance for your answer.
Maria J. Kendrick RN
The Flushing Protocol cards from INS released last year states that all CVCs can be flushed with 10 units per mL for all therapies. The only exception is when deaccessing an implanted port and then 100 units per mL is recommended. These new recommendations are based on everything this committee could find in the literature and the expert opinion of this large group. There are no other studies comparing doses, frequency, etc. I would not recommend withdrawing any amount of blood to remove the heparin except when large quantities (more than 1000 units per mL) are used for dialysis catheters. This could add to the risk of nosocomial anemai and infections from the increased hub manipulation. The half life of heparin is very short. I would only be concerned about this in the patients that have any bleeding problems but I would hasten to change your policy and procedure to 10 units ASAP.
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
THANK YOU SO MUCH!!!!
Maria