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Diane Gilbert
push/pause flushing
The infusion center I work at teaches and uses the push/pause method for flushing CVADs.  We have taught this method to inpatient nurses, students and home care patients.  Is there any new information to support or negate this practice since this topic was last visited around 18 months ago?
lynncrni
There is not any new

There is not any new information. The idea that this flushing technique will "clean" the catheter walls is probably false. We know that biofilm and fibrin forms at very high flow rates and that it adheres firmly to the catheter. We also know that biofilm can break off in clumps or by streaming motility. There has never been any outcome data published about this technique, so we have not true idea of what is or is not doing. At best, it can be used to flush whole blood that was aspirated into the catheter lumen. But I do not believe it can render any benefit to biofilm and fibrin that is already adhering to the catheter walls. There is the concern that this technique could increase the amount of biofilm that breaks off, but there is no evidence of this yet either. Lynn

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Tom4Shield
Push Pause

So, If Push-pause is the method taught and proliforated throughout the country, why hasn't it been studied extensivly to insure that it's a 'proven' method? Just wondering...

Tom Burns, RN BSN

Clinical Nurse Edu

lynncrni
 Because we got the cart

 Because we got the cart before the horse! We should have had the science then began the practice based on the outcome of that science. This practice is not product-dependent, so no manufacturer is willing to invest in this research. And no other group has taken up this cause. So I really do not know the true reasons, but that is just the way it is. Good question though, Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gina Ward
push pause flushing method

 

Marcia Ryder discussed this in a part of her presentation.  She presented information from studies that  when they  drew blood  back into a line and then had them flushed three different  ways,( three different groups)  one flushing with 10 ml normal saline push, other with 10ml normal saline in push pause, then other with fluid running .

Then they tested to see how much of a return of the blood protiens and products they got back ( say in the blood stream versus staying in the catheter) after flushing those different ways.,.  they felt that they had 97% return of blood products when doing the push pause technique, so.......she recommended the push pause technique as a better flushing method to clear a line after blood draws or any instillation of meds.   I am sure I am not quoting it  exactly correct but that was the jist of it.

 

I too wondered, what if this pushes some of the biofilm off of the internal lumen of catheter or hub.  But we also know the biofilm will continue to allow the microorganisms to grow, replicate them selves and then be released into the system even if we didnt push them off the wall.  I believe what she was saying is if we do push pause flushing from teh start we can help reduce the amoutn of blood that we leave to coat the inner lumen of a line and therefore reduce bacterial etc....growth. 

She was also adovocating the use of antibiotic/heparin coated catheters in this aspect as well as thrombosis prevention.....

 

Very interesting stuff....  Gina

 

Gina Ward R.N., VA-BC

lynncrni
 I read that study before it

 I read that study before it was published and have many questions about it. I do not think it provides the information we need to endorse the so called push-pause flush technique on a wholesale basis. On the other hand, this technique may not be doing any harm either, but we have no evidence for that. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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