We are thinking about changing to a 10:1 heparin flush for all central lines (except ports) from the 100:1 heparin flushs we currently use. I've been looking for supportive data, but have been unsuccessful. Does anyone have any reference material that would support changing from 100:1 heparin to 10:1 heaprin?
Greg Bowman, RN
Clinical Supervisor, IVT
Swedish Medical Center
Here is one that was used to establish the new recommendations for 10 units per mL for the INS Flushing Protocol cards:
1. Buswell L, Beyea S. Flushing protocols for tunneled central venous catheters: An integrative review of the literature. The Online Journal of Knowledge Synthesis for Nursing. 1998;5(3).
This article reviewed 6 studies and strongly recommended that tunneled catheters be flushed with 10 units per mL.
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
Lynn: I'm still not having much luck identifying which study in your reference list that supports using 100u/ml for ports...the brazilian study with rabbits is in r/t saline vs. heparin. Any other helps? We'd like to standardize to 10u/ml for all non-valved devices, but don't have evidence yet either for or against.
anyone else have comments/suggestions?
Thanks in advance,
Mari
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
I don't think you will find a study specific to implanted ports and the concentration of heparin. This is the only study I have ever seen about flushing implanted ports:
Kuo Y, Schwartz B, Santiago J, Anderson P. How often should a Port-A-Cath be flushed? Cancer Investigations. 2005;23:582-585.
This is one of those questions where there is no published studies, so we must rely on expert opinion such as the new flushing protocols from INS. This is a form of evidence, although it is lowest on the hierarchy.
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
Thanks, Lynn.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Order the Flushing Protocol Cards from INS. They contain all the needed info about different types of catheters, different therapies, and ages. Locking an implanted port is the only time that 100 units per mL of heparin is recommended.
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