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Kristin Walker
Our hospital just recently made it a rule that all Heparin needs be double checked and co-signed for.  We are flushing all of our Picc's and Midlines using the SASH protocol which means the RN will need be pulling another RN to check 100 units of Heparin every time the line is flushed.  Does anyone see any way around this rule and are all of you out there doing this?  I personally don't see the sense in it since our pharmacy doesn't stock any Heparin on our floors except the 100 unit/ml concentration.  Any input would be greatly appreciated.
Timothy L. Creamer
 One effective "way around

 One effective "way around this rule" is to delete the need for Heparin on your PICC's and Midlines. There are PICC's with valves both distally and proximally (Groshong, PASV, and SOLO). The SOLO is the only one currently indicated for saline only, CVP monitoring, power injectable, and in a triple lumen configuration. The cost difference for a valved catheter will be significantly less than compared to the cost of heparin, syringes, and nursing time for co-signing. Groshong valve is available in Midline single lumen only.

Hope this helps.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Timothy L. Creamer RN, CRNI

Clinical Specialist, Bard Access Systems

Florida Division

I think we should be

I think we should be planning to eliminate heparin from all catheter locking procedures, however I strongly believe that we are not there yet. Heparin is still the only anticoagulant with a labeled indication for locking catheters, but there are several others going through the FDA processes now. Of course there is no way to know when these will be available.

A valved catheter is one alternative but that requires more change than you may be able to make at this point. I also want to bring your attention to the fact that 10 units per ml of heparin lock is quite sufficient. You did not mention if the nurses are expected to draw this heparin up from vials or if you have prefilled syringes with heparin lock solution. If they are still using vials, I think your policy is very wise. There have been numerous incidences reported where a therapeutic dose of heparin has been confused with a heparin lock vial and resulted in patient harm. The worst was several infant deaths. So the best alternative may be to switch to a prefilled syringe for the heparin lock solution. 

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

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

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access System

Is sounds like the hospital does not have bar coding/scanning.  This is not 100% full proof however

I do not think the policy is out of the box in light of recent errors with heparin and heparin is on the list of top drugs for errors

My suggestion is find a way to go heparin free by caps, catheters, or good flushing practices.  Do a month without heparin and compare the results to a month with heparin.  Investigate


Kathy Kokotis

Bard Access Systems

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