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Flushing Guidelines for Central Lines

Hello everyone,

Could anyone provide me with Flushing Guidelines for use at our institution. I always follow INS standards but I did not find a central line flush protocol within the 2021 INS Guidelines. Did I miss this chart? If I didnt, can someone point me to an evidenced-based flushing chart to include in our policy.


Thank you,

Michell Leeper, BSN, RN, VA-BC

The INS SOP has a standard on

The INS SOP has a standard on Flushing and Locking with many details based on  the evidence. It is not in a chart form, but INS also has flushing cards for purchase. You are always going to flush with a 10 mL syringe, flush in 2-3 mL checking for resistance, then aspirate for a blood return, then flush in the remainder of the saline. After the med is infused, flush aagain with 10 mL saline using a push pause technique. Disconnection is based on the type of needleless connector being used. See SOP on Needleless Conectors for that information. Know which brand of NC you are using and if it is negative, positive, neutral or anti-reflux. Most prefilled syringes do not cause syringe-induced reflux but a regular syringe that you or your pharmacy fills does. For a traditional syringe, you must leave 0.5 to 1 mL of saline in the syringe to prevent gasket compressions that then expands and causes reflux. Heparin is a final option for locking but the outcomes with heparin are the same as with saline. So heparin is a risk that you do not need. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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