Our hospital Med Safety pharmacist is working to instute the 10u/ml of "Heparin Locking" for central lines. Meanwhile, we still follow saline with 5ml of 500u/ml heparin.
The INS flushing guidelines recommend flushing unused lumens at least q24 hours. Someone has recommended that policy is be changed to Q12 (from Q24).
I'm guessing the reason for the change is so the line gets assessed each shift. (I haven't had the opportunity to ask the right person yet.)
My questions: What are the benefits of flushing an unused line/lumen more than once a day? If an additional flush is believed to be beneficial, I feel we should wait until we're using the lower dose of Heparin (or saline only).
Can it be argued that the additional flush (connection) increases the risk for CLABSI?
Do you believe the increase in cost of line maintenance (nursing time and supplies) will pay off?
Thanks so much,
Deb
I have been immersed in the published literature on all issues related to heparin flushing for many months. I was also part of the INS Flushing Task Force that created the protocols. These protocols are based on what little published evidence there is along with expert opinion. There really is no evidence to provide to address your questions. We know that patients in home care have therapies infused once per day with flushing at completion and there is no increase in occlusion rates. Patients in ambulatory care could even go more than 24 hours between infusions. I do not endorse a saline only flushing protocol based on the use of needleless connectors because there are studies showing that outcomes of infection and occlusion are worse with this method. Discussions with many people reveal anecdotal information about increasing use of tPA with the saline only and needleless connector. Yes it could be argued that flushing q12h increases manipulation of the hub and therefore increased risk of CRBSI. Flushing q12 also will increase the cost. Finally, I would ask why do you have so many lines where therapy is not being infused? This should be rare due to the CDC guidelines to "promptly remove any intravascular catheter that is no longer essential." So maybe some of these lines should be removed rather than maintained? Lynn
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