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CVAD maintance care

 I am in the process of updating our CVAD flushing policy and was wondering if anyone has recommendations. Our current policy is to flush every 8 hours with heparin and saline if not in use, but accessed.  I do not believe that this is best-practice, but I have not found anything definitive that states this. If I am reading correctly, the INS standards does not indicate the frequency of flushes, but recommends facility policy. Bard’s recommendations are every 28 days if not in use or after each use. This is a company recommendation so I do not know if there is enough evidnce to implement their recommendations.  Does anyone have any suggestions?

Thank you!

"if accessed" sounds like you

"if accessed" sounds like you are talking about an implanted port. Frequency for all VADs would be the same though. The INS SOP does address this but most do not interpret it correctly. Read the Standard statements in the Flushing and Locking standard. That tells you when to flush and when to lock any VAD. The frequency for flushing and locking any VAD when it is not being used for infusion has not been established by evidence. For most VADs, they should not be allowed to remain in place if there is no infusion being given. If they are removed correctly there is no need for a frequency to maintain patency. For those long-term devices like a tunneled cuffed CVAD or implanted port, those may be needed for future therapy so may not be removed. The manufacturer recommendation for 28 days is another clue that you are asking about implanted ports. If there is no infusion, it may not be removed but why is the access allowed to remain in place? Flushing and locking every 8 hours is not supported by evidence for any type of VAD. It only means more manipulation and no evidence that it improves patency. If you cannot get acceptance of removal of a port access needle when the therapy is finished, then you must reach consensus on the frequency of flush and lock among your committees. Daily should be sufficent. Also you can delete the heparin as the outcomes for heparin and saline locking are equivalent. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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