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Vickie
Maintenance of CVC after hospital discharge

Our infusion nurses were having a discussion about teaching patients/families how to flush their CVC at home after they are discharged from the hospital.  For lines that need to be flushed for maintenance only (not receiving meds), is it ok to flush with heparin only?  For example, a patient may have a PICC line in place for chemo administration every 3 weeks.  They are taught to flush the PICC line daily with heparin (no saline) only between teatments to maintain catheter patency.  Is this acceptable or should the PICC line be flushed with saline and then the heparin daily?    


lynncrni
Are you also teaching your

Are you also teaching your patient to make any type of assessment about the catheter when they flush? If so, you will need the saline as well as heparin. Think in terms of flushing with saline and locking with heparin. Both concepts are necessary. If you are only teaching your patients to instill a dose of heparin and not do any type of line patency assessment such as check for a blood return, assess for resistance, then heparin alone should be sufficient. Are you also emphasizing the correct flushing technique based on the type of needleless connector being used? This is equally as important as the solution itself. 

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

Barbara Tinsley
Our infusion center is part

Our infusion center is part of a large BMT unit. The clinic that refers our patients teachs them to flush at home with heparin only. We have noted that these patients have a higher rate of occlusion. We believe this may be due to the fact that saline flush is a larger volume allowing for a more adequate flush. When we placed these patients back on saline and heparin flushes our occlusion problems dropped dramatically. The clinic taught heparin only because they wanted to decrease the manipulation of the line and therfore decrease the chance of CRBI, we believe the build up of biofilm with inadequate flushing contributes more to CRBI. Teaching is the key here, as well as making sure there is a willing and able caregiver.

Barbara Tinsley

Jan Hull
We have five outpatient

We have five outpatient infusion centers in our system. We only flush hickman's and ports daily. Everything else is weekly or before and after use. We routinely use saline only for all other lines. We only flush with heparin when it is open ended.

Jan Hull BSN, CRNI
[email protected]

lynncrni
Biofilm production is

Biofilm production is directly related to the introduction of organisms into the lumen. There has been no published connection to flushing techniques and the development of biofilm. Flushing techniques can and do lead to fibrin/thrombus development when the correct flushing technique is not used for the specific type of needleless connector being used. Negative displacement needleless connectors require positive displacement flushing technique however positive displacement connectors can not have this flushing technique used. The other issue in eliminating saline and just using heparin is contact between incompatible meds in the lumen that creates drug precipitate. Both of these factors contribute more to the issue of lumen occlusion that biofilm development. Lynn Hadaway

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

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