Currently our policy for confirming CVAD patency is to check for blood return then flush the line with saline. One of our doc wants nurses to discard it instead to prevent potential "bacterial shower" and minimize risk for HIT. Is there strong evidence to support this practice? How do we balance it with the risk of anemia due to frequent blood discard? Thank you.
He is way off base on the HIT prevention! HIT is not dose dependent, so aspriating the hep lock solution is totally unnecessary. Bacterial showers could be an issue especially on a long term CVAD. Are you talking about inpatient or alternative site? How frequently are you talking about discarding blood? I would never recommend this because we already have a huge amount of evidence on hospital-acquire anemia and discarding blood is a major cause that frequently leads to the need to transfuse the patient. The INS Standard on Phlebotomy discusses ways to conserve blood to decrease hospital acquired anemia. 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,
Thank you for your response. It is for inpatient areas - specifically for long-term tunneled catheter in malignant hematology population. Our current practice does not require a discard when accessing the line in effort to minimize the unnecessary waste of patient's blood - especially most of these patients already require frequent bloodworks. Would slower flushing of the lumen prevent the bacterial shower event?
No good evidence on this that I can think of. The showers come from breaking the biofilm lining the internal lumen. Turbulent flushing will disrupt more biofilm so if you are doing that you might stop. But I am not so sure that it would reduce the bacterial showers. The best thing is to reduce the biofilm formation by strict attention to care of the hub - scrubbing the luer lock threads when a set or needleless connector is changed, removing the needleless connector for all continuous infusions (their purpose is for intermittent infusions), scrubbing the connection surface with each and every entry into the system (intermittent meds would = 3 or 4 scrubs, use of a disinfection cap between intermittent uses, and correct use of all primary, secondary, and intermittent IV set, changing them per INS standards and never disconnecting a continuus infusion for ambulation, toileting, etc, use a rolling pole and take it with the patient. All of these decreases hub manipulation and therefore decreases the biofilm formation. 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