Our policy states that we must flush our un-used or intermittently used CVADs every 8 hours with 2 - 3Â ml of Heparin Flush.
We are currently using Heparin Flush Solution 100u/ml.
Let's say the patient receives antibiotic treatment and pain management via that intermittently used lumen.Â Let's say, antibiotics every 6 and 8 hours.
INS papers say that a lumen should be flushed with 1 to 2 times the amount of solution held by a lumen.Â
Most lumens will hold about 1ml or slightly more.
Some of our nurses have asked ifÂ they are putting too much Heparin in the patients by following the policy.
We sort of agree with them but until the policy is changed and we ask the hospital to switch to a 10 units/ml concentration, what should we teach the nursing staff that cares for these lines?
One of the suggestionsÂ I gave was to withdraw 1 to 2 ml of blood when checking the line for patency before infusing medications, thus removing a small amount of Heparin flush from the line and not instilling it in the patient, but, realistically, the patient has already gotten at least 150 units more than needed the last time the line was flushed.Â Multiply that amount by 6 (the numbers of times the line isÂ flushed with Heparin FlushÂ if on antibiotics Q 6 and 8) and the patient has received 1200 (to 1800) units of Heparin.
The new Flushing Guidelines by INS recommend 10 - 100 units/ml when flushing adult CVADs, but I don't recall reading a STRONG recommendation.
Does anyoneÂ know of any article I could get my hands on to prepare for the next Policy and Procedure review that would be of help in resolving this problem?
I thank you in advance for your answer.
Maria J. KendrickÂ RN