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Flushing and locking requirement for multi lumens CVAD


I am new to this site and want to say thank you for creating such a wonderful forum where nurses like me can learn from the experts. I have a quick question 

In Rehab setting, we locked patients' CVAD when they went for their activities (2-3x/day). Some of these patients have multi-lumens CVAD as they may still require IV therapy. 

Best practice recommends minimal manipulation of the catheter lumens to reduce infection. Should we just flush and lock the lumen that we used and flush the dormant lumen as per routine maintenance schedule? Or should we flush and lock all lumens everytime one of the lumen is access/deaccess?

Thank you -




 Maybe I am reading too much

 Maybe I am reading too much into your post but let me see if I understand what is happening. Your patients in rehab have multiple lumen CVADs and some require continuous infusion through one lumen. So you are disconnecting this lumen 2 or 3 times per day. This means you are flushing and locking this lumen 2 or 3 times per day. My first question is what is in those primary continuous IV fluids that the patient is not receiving while in therapy? Heparin, vitamins, electrolytes? Other medications? You may need to re-think this method of stopping these infusions and find ways to allow them to continue infusion during other therapies. 

This disconnection and reconnection increases hub manipulation and the risk of infection, so my opinion say not to allow this. But you have to make a judgment based on patient needs. If there is no medications in the primary infusion, and the patient is drinking, ask if you can get rid of the continuous infusion, leaving only the intermittent medications which can be infused at times other than other activities. 

If this can't change, then this lumen must be flushed and locked each time it is disconnected. That should be more than sufficient to keep it patent. The other lumens should be flushed and locked after each use. For lumens not in use, they should be flushed and locked on their regular schedule. 


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

Maybe I reading too much

Sorry for being unclear.   This patient has double lumens PICC. One lumen is dormant, the 2nd lumen is used for q8h antibiotics. While on rehab, both lumens are locked as per-policy.

Based on your response, I gather we should flush and lock the 2nd lumen after each use, while flush and lock the dormant lumen as per standard schedule.

Thank you - Diana

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