Our pharmacy would us to just use normal saline to flush all central lines. I am afraid
of seeing catheters occlude. We flush with 10-20 ml of normal saline followed by
5 ml/100 unit heparin (if no IV infusing of course). I know that some hospitals are
using 10ml/heparin (except for ports). What are hospitals using? I would appreciate
your help.
See INS standards on Flushing and Locking with the supporting evidence for heparin for CVADs. 10 unite per mL is recommended except for when de-accessing an implanted port. Not enough evidence for saline only in CVADs to change the standard yet. 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
I would like to know about flushing and locking protocols for implanted ports. I want to know how much if any Heparin is used for inpatients who recive an IVPB, one or more in a 24 hour period. This is a patient not recieving maintenance or a TKO rate.
Thanks
Kathi Kesner Med/Surg Nurse Educator, Albuquerque VA Health Care System
When the implanted port is accessed and being used for intermittent infusions, you can use the same protocols as with other CVCs. Saline, medication, saline, heparin 10 units per mL. Locking volume should be twice the internal volume of the entire system - catheter + port body + access needle and extension set + needleless connector. When you remove the access needle, you should lock with heparin 100 units per mL. See Infusion Nursing Standards of Practice on Flushing and Locking, 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
Lynn,
Thank you for responding. . I just discovered this website . It is very helpful and informative.
I have seen this info in my literature search using just 10units/ml heparin for daily intermittent use on inpatients but could not find studies that supported it. INS standards don't actually use this particular concentration for daily intermittent port use. Is your recommendation of 10u/ml based on experience or actual studies?
Thanks very much for your assistance.
Kathi Kesner
An implanted port is a CVAD. See INS Standard 45, Practice Criteria O & P. See the references used. 10 units per mL for CVADs have multiple references and a ranking of III. 100 units per mL for deaccessing an implanted port has 2 references and a ranking of V. Please refer to what those ranking mean in the front of the standards. 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
Hi, Lynn is correct of course regarding the INS Standards, but if I understand your question correctly, you are wondering what other hospitals are doing. I would say in my experience visiting many hospitals all over the country, that most are using both NS and Heparinized saline either 10 or 100 u/mL and 3-5 mL per lumen to lock catheters if nothing is infusing. This is also very common practice in Long term care facilties and homecare. There has been a recent (within the last 2 years) push to eliminate heparin whenever possible. So more hospitals, homecare agencies and long term care facilites are using valved catheters as an option whenever possible and also looking at connectors (valves, end caps) that can be used with NS only, ones with a Neutral displacement or positive displacement and have a NS only recommendation by the manufacturer.
The real question, as you have asked, is will the line remain patent? I think that is something that really needs to be determined on a case by case or individual basis. Some hospitals are quite successful.
Keys to success include: Understanding of the various types of catheters and how they work
Understanding of the connectors in your hospital and how they work
Proper use and flusing of the catheter and connector
Assessment of patients at high risk for occlusion and implementing a heparin protocol on those patients only.
This is some things to consider as you decide how to procede. Good luck
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Chris is correct about all the points you need to know about your products and practices. My message was to emphasize that we should be making practice decisions based on the evidence and that evidence is detailed in the INS standards of practice. There are numerous variations in staff, patients, policies, procedures, and practices between facilities. So your decisions should look at the evidence, along with collecting your own evidence. Actually, the question was about the practice of locking a catheter instead of flushing - again those terms are defined in the INS SOP. Saline is always used for flushing, but the big question remains about the locking solution. I know that many hospitals have based their practice on what the needleless connector manufacturers are recommending with their specific product. I would love to see more nurses asking these sales reps for real clinical data on the true and published outcomes with their products and saline only locking. Also what is the incidence of tPA use with saline locking? Most manufacturers will only have bench testing data instead of patient outcome data to share. And most hospitals are not assessing the use of tPA when they make a change. So someone could tell you that our nurses love product XYZ but that means nothing without data to back it up. 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