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Flushing standards for CVC's and PICC lines

I am looking for as much feedback as possible in regards to the most recent standards of practice for flushing CVC's, Implanted ports (porta-caths) and opened ended non-vavled PICC lines.  All central lines in the facility where I work have positive displacement end caps placed on them.  I am interested in finding out if the use of Heparin Lock Flush (100units/ml) in a pre-filled syringe considered the standard of practice to keep patent "non-use" or "intermittent use" lumens of the above stated catheters.  Is "SASH" still considered a relevant practice?  If so, is the concentration of Heparin 100units/ml the standard and how often should this be done?  Also, is this considered a dwell and should it be drawn off before the line is used?  I am also interested in finding out what the current flushing standard is with non-tunneled and tunneled dialysis catheters in particular with the use of Heparin in regards to concentration and amount per dwell.  With all dialysis catheters, we always draw off the concentrated Heparin before these lines are used.

One last it the INS or another source that sets this standard of this particular practice and if so could you please advise where I can look for these latest standards.

I appreciate and thank all of you in advance for any information you can give me on this subject!



It is the INS and you can

It is the INS and you can find several resources at their website, First and foremost you need the Standards of Practice as this is the legally authoritative document that you and your staff are held accountable to. All p&p should incorporate these standards. INS also has a policy and procedure book and most recently, they released flushing protocols in the forms of laminated cards. SASH is still the recommended method unless you are using a positive displacement connector **with** instructions for saline only flushing. Some, but not all, make a recommendation for saline only. Check the instructions for the brand you are using. Heparin 10 units is now recommended for all catheters except when you are de-accessing an implanted port. This is the only time that heparin 100 units per ml is recommended. Both of these doses of heparin are flushed into the patient and not withdrawn, however, you always need to aspirate for a blood return before using each catheter for any infusion. 

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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thank you Lynn!  I

Thank you Lynn!  I appreciate your very valuable advice and information!


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