At our hosptial we flushTLC with 1:100 Units Heparin. The ICU is NOT doing this because the intensivist do not want their pts getting heparin. So, when the pts get transferred out of ICU they then have to start on heparin flushes if they leave the ICU with their TLC. I have read the INS standards. Is it ok to use preservative-free 0.9% sodium chloride (USP) flush only? We use the microclave for an end cap. We would make policy changes to ensure that the TLC are getting flushed regularly on the units at least every 8 hours. Does this seem appropriate to decrease the risk of HIT which is the overall intent of the intensivist I think. It doesnt seem like it would be wrong. Please advise.
As you have read the 2011 Standards state that heparin 10 units per mL should be used to lock, not flush, all CVADs. Saline is used for flushing. At that time there were no published clinical studies on outcomes comparing saline to heparin for locking CVADs. We did have instructions for use from several types of needleless connectors stating that heparin can be eliminated, but that is not based on clinical evidence. Since the INS SOP was released there have been 3 studies showing that the outcomes with saline and heparin for locking CVADs are equivalent. Is equivalence enough to support saline alone for CVAD locking. Can those studies be generalized to your patient populations and catheter types? You will need to do a lit search to find these ansswers. Your practice should be evidence based. I would also agree that your practice throughout the entire hospital should be the same. Have you assessed the frequency of HIT in your hospital? Has this occurred when only heparin lock solution was being used? What is the rates of lumen occlusion in your hospital? All of this information would be necessary to make the best decision for your patients. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
New ASCO guidelines recommend saline locking of ports and tunneled lines. Not sure how PICC fits in but these came out in 2013
Kathy Kokotis
Bard Access Systems
Kathy Kokotis
Bard Access Systems