Someone asked me a question before the site went down. Now I can not find that thread but I do remember the issue was about flushing and locking CVCs. The poster thought that the trend was moving away from heparin as a locking solution and toward saline only. That may be a common approach to locking CVC but it is not an evidence based practice. The standard of practice will remain heparin lock solution as the recommended solution for locking all CVCs based on the available evidence. We have a small RCT that did not show statistical significance but a serious financial impact with declotting 6% of PICCs that would become occluded. A large RCT from Italy has shown that locking with saline only with a positive displacement needleless connector has a rate of infection and occlusion that is double the rate with heparin lock. An finally a systematic literature review found that the available evidence for heparin was not enough to make an recommendation. When we switched from heparin to saline only for peripheral catheters about 20 years ago, this was based on 2 meta-analyses showing that the outcomes were virtually the same. So we could eliminate the heparin lock for short peripheral catheters and have the same outcomes. We do not have that type of data yet for CVCs. We have the limited data showing worse outcomes. And removal and reinsertion of a CVC carries significantly more risk than a peripheral catheter, therefore it is my opinion that the bar should be higher for CVCs. In other words, not just equivalent outcomes but the alternative locking solution should have better outcomes. We do not have that yet with saline only and I have my doubts that we will ever get it. Lynn