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Patti Atteberry
Central line flushes

I am looking to revamp our flush protocols.   Presently we flush  open central lines with 5ml NS before and after medication and daily if dormant followed by 5ml (10unit) heparin.   Groshongs are 5ml NS before and after medication and weekly if dormant.   I would like to change to  10ml NS instead of 5ml.   Does anyone see any problems with this?

Also, we supply 10unit heparin but quite often our HH agency has to work with an outside infusion company and they often use 100 unit.   Is there any information what is the best amount to flush with?   I have found everything from 1-5ml of 100units.   The INS standards states the flush amount should be equal to at least twice the amount of the catheter. It also states that heparin should be the lowest concentration possible to maintain patency.   I would like to include a 100unit amount in our protocol, but we will continue presently to supply and use the 10unit from our pharmacy.   I probably just answered my own question but I would like to know what others are doing?

One other thing, recently there was conversation regarding the caps/valves with TPN.   The CDC states the 'tubing' should be changed with each bag (every 24 hours) but what about the  valve (we use the CLC 2000 positive pressure valve).   Should this also be changed?   Is this necessary when the infusions are continuous, should we connect without any device?  

Is there any documentation regarding any of these, other than what I mentioned from the CDC and INS?   These are the two I primarily go by but I would like something to help me get more specific with my changes.

Thank you once again,

Patti Atteberry, RN, CRNI

OSF Home Infusion Pharmacy

Heparin flush question

I just finished a lengthy literature review on heparin locking and it will be published in the Winter issue of JAVA. Watch for that article to answer some of your questions. When any catheter is used on a regular basis, I think 10 units per ml is sufficient.

CDC guidelines also do not state that the tubing for TPN should be changed with each bag. Tubing used for fat emulsion should be changed at least every 24 hours, but if no lipids, the TPN tubing can remain up for 72 hours. CDC also states that the needleless connector should be changed at the same interval as the tubing.


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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Barbara Lodahl
Cap changes w/ TPN/Lipid tubing

We've not been using heparin for several years on any CVC except implanted ports and it's been very successful. However, we've been using the add-on PASV valves w/ a positive pressure cap. Now that add-on PASVs are no longer available, we're also having to revisit heparin flush vs. finding another cap marketed w/ Saline Only required. I'll be looking forward to seeing your article, Lyn.  I've also read the recommendations for cap changes w/ tubing changes. I'm wondering what's the point in using a cap at all if it is being changed w/ each TPN tubing change? It doesn't seem to me the cap serves any purpose in this situation and only becomes an added expense?

Alma Kooistra
Lynn......what about when
Lynn......what about when the lipids are piggy-backed into the low-Y of the TPN tubing.  Doesn't that then turn it into a tubing that needs to be changed every 24 hours (aka with every bag change)?
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