We are updating our policies and found some confusion with the nurses for flushing implanted ports when the patient is not on a continuous infusion. Most of the literature says to flush the ports with Heparin 100u/ml 5ml when not in use.
My problem is what happens if the patient is getting q4hour dosing and receiving 500u of Heparin 6 times or more a day? That equals 3,000u/day in Heparin. Do we really need that much Heparin when a patient is in the hospital and the line is being accessed that often? As of now we are lowering it to 100u/ml 3ml but I would like to see Heparin 10u/ml used instead or even just normal saline flushes.
Anyone have a protocol that is working to keep the port open without giving so much Heparin?
Anyone have any literature on using a lower dose?
Thanks for your help.
INS Standards recommend 10 u/mL. Use 100 u/mL only when deaf easing. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn, I was going to email you about this anyway.
Karen Y. VA-BC
Denver CO
Lynn--I think spell check misrepresented "Deaccessing" as "Deaf Easing"?
Robbin George RN VA-BC
OMG you are right. This was sent from my phone and I did not check it carefully. Thanks for catching that. It should be deaccessing. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
LOL. I accually googled that new phrase! lol :)
We work a lot with ports in Belgium and yearly, in our institution, more than 1300 ports are inserted. Before 2008 we locked every port with a 500U/5 ml heparin with a limit of 2000U/day, otherwise de-accessing was replaced with a continuous infusion. In 2008, a shortage of heparin forced us to change our protocol. We reduced the volume to a 300U/3ml lock and also the frequency we reduced. In the hospital, at the end of IV therapy, the ports were flushed with a 10 ml of NS and locked under positive pressure without a subsequent heparin lock. When the Huber needle was withdrawn, only then the 10 ml NS flush was followed by a 300U/3ml heparin lock.
We recently conducted a study comparing normal saline versus diluted heparin to lock ports. Ports in the NS group were only flushed and locked with NS en ports in the heparin group were locked with 300U/3ml of diluted heparin (only before needle withdrawal at discharge). We tested the hypothesis that a NS lock will not result in more functional problems, and more catheter-related bacteraemia episodes compared with a heparin lock. The results of the study show indeed no more problems in the NS versus the heparin group. I will be happy to send you a copy of the study, just contact me at [email protected]
Please show me where the standards say that when a patient is receiving therapy, the port should be locked with ONLY 10 unit per ml Heparin Flush. All I see is standard 45.4 - P saying that Before removal of access needle AND/or periodic access and flushing, the device should be locked with 100 unit per ml Heparin lock solution.
Is it because section O delineates 10unit per ml being the preferred lock solution after intermittent use? I agree that 10unit per ml Heparin Flush is an acceptable and preferred solution when doing the SASH method and intermittent dosing, but our policies are NOT reflecting this as it pertains to Implanted Ports.
TY in advance.
Diane
In Standard 45 Flushing and Locking Practice Crierria O. "Due to the risk and costs associated with central vascular access device (CVAD) insertion, heparin lock solution 10 units per mL is the preferred lock solution after each intermittent use. Ranking of III supported by 6 references. An implanted port is included in the CVAD group along with PICCs, nontunneled percutanerous, and tunneled cuffed catheters. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Why is it not standard protocol to access and discard all lock solutions that are not saline? We are updating our Flush/Dwell(Lock) Guidelines and this seems to be a point of discussion.For safety sake, it makes sense to discard the dwell(Lock) solution before attempting to flush. I welcome your comments.
James M. Joseph MPH, RN , BSN, CRNI, VA-BC
It has never been the practice in the US with the one exception of hemodialysis catheters when using 5000 units per mL. We have always approached this by using routine lock solutions that are safe enough to be flushed into the bloodstream. I think it would be an enormous nightmare to change practice in the US at this point. Lock solution would only be discarded when the solution would cause side effects when flush in, example 70% ethanol. I realize that "we have always done it this way" is not a good reply to a practice change, but in this case I think changing to aspiration of all lock solution would cause more problems. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861