Has there been any progress made in developing flushing recommendations following the new Standards?
Watch the National Home Infusion Association web site or journal in the next couple of months. It has been written just not published.
C. Craig Farris BS,RN, CRNI
I am not sure what additional information you need from your question. INS has updated their Flushing Card Deck. What questions do you have? Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
The flushing card deck currently available is the updated one? Just confirming.
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Yes, cards now available from INS are the updated versions. Numerous guidelines state that the presence of a fever alone is not a valid reason for removal of any VAD. And there is no evidence that fever requires delaying insertion of any VAD. The same for positive blood cultures - no evidence to hold insertion. Some infectious disease physicians may prefer this, but this practice is based only on their experience, not science or other guidelines. Lynn
Can you tell me what the INS based the new tables on? We are in quite a quandry of how to revise our hospital's flushing policies since the INS Standards now states there is not compelling evidence to recommend one locking solution over another.
I have not seen the flushing cards but I know what is being sold are the updated ones. I worked on the Flushing and Locking Standard though. Evidence in multiple studies on a variety of CVADs have shown equivalent outcomes when locking with NS or heparin 10 units per mL. One of these solutions is NOT superior to the other, therefore the standard must accept both of these solutions. There is a vast difference between flushing and locking - please see INS SOP Glossary definitions. You are asking about locking, not flushing. What solution you choose must consider the type of needleless connector being used. If you are using a negative displacement NC, you should follow those manufacturer instructions and choose heparin 10 units per mL. For positive displacement or neutral NC, instructions state you can use either NS or heparin 10 units per mL. Please note these studies show that the clinical outcomes are the same. There are no studies showing that one is superior to the other for lumen patency. Lynn