For PICCs and long term CVADs that are not being used for medication administration:
-Is flushing with normal saline and aspiration for blood return required prior to renewing the heparin lock?
-Or can a new heparin lock be administered without flushing or patency check?
A 2015 article per Goosens “Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit” states that between two locking procedures, when the catheter is not in use, “When the lock is renewed, the new locking solution may be instilled without aspiration of flushing with NS” (p.5 of the article).
This article is cited in the 2016 INS Standard (40) for Flushing and Locking as well.
Thanks for your input on this.
Paula
First and foremos - why are these CVADs left in when they are no longer needed for infusion therapy? The standards and guidelines call for immediate removal. The only exception may be surgically inserted implanted ports and tunneled cuffed CVADs if there is some concern that therapy may be needed again soon. Otherwise they are a serious risk for DVT and BSI. If there is no blood return, it is not functioning. If you don't check for a blood return then you have no idea that it is functioning. If it is not functioning there must be some reason and it needs to be assessed, usually by radiology. So save everyone a lot of time and expense by removing this when therapy is complete. PS, just because a study is used in the INS SOP, does not mean that ALL statements in that study are endorsed and supported. It means that is a resource that may provide additional information for your detailed question. I would always aspriate for a blood return to assess functionality.
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
Lynn,
Thank you for the input. I've been in ongoing discussions with our pediatric hospital regarding lines not being used and how to maintain/flush them in the home (I work for a home care agency that cares for patients from our system's pediatric hospital). These lines are typically pediatric oncology patients with double lumen broviacs. One lumen is being used for chemo infusion. One lumen is not being used for med administration.
The pediatric hospital's policy for lines not used for medication administration is heparin flush/lock that is renewed every 8 hours - which is expected to be continued for home care patients. The Goosens article was presented to me as proof that INS supports this because it is cited under standard 40 - thus the question to the forum.
Appreciate your straightforwardness.
Paula
Thank you for the clarification.
Someone is grossly misintrepreting the standard. Read the actual standard statements which tells you the purpose of flushing and locking - 2 different purposes. Those purposes direct the frequency. There are no other studies about frequency for locking any VAD. If there is no integral valve inside the catheter, flush and lock once per day. More than that is only going to add contamination risk due to manipulation. Use of a study as a reference is NOT to be interpreted that every word of that publication is applied to the SOP. If there is a valve inside the catheter itself, follow manufacturer recommendations which is usually once per week.
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