Does anyone know of a reference, guideline or recommendation for a maximum dose of heparin to be given via heparin flushes to maintain catheter patency, in a 24 hour period? (Putting all aside that heparin free flushing is preferred- looking for a recommendation when saline might not be an option.) Thanks much.
max dose 15/kg/hr.
if higher than above, need to check coag.
reference: lexi-comp dosage handbook.
There is no maximum, however you should always use the smallest dose possible. The new INS Flushing Cards call for 10 units per ml for most all situations. Those cards can be ordered from INS now.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Hi, Lynn:
We're almost finished revising our vascular access policies, and working on the last one - Central Venous Access Devices. I'd like to be able to include 10unit/ml flushes for adults as well as peds - do you know what literature INS is basing this on?
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Just answered my own question - I spoke with Kathy at INS, and have your reference list from yesterday's webinar.
Thanks, Lynn
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
With the issue of decreasing the amount of heparin used for flushing, and the move to going to saline only flushing, now I'm hearing about the use of heparin decreasing the risk of infection? I know I've heard that about tPA and the issue of removing blood fibrin/deposits from the catheter as a medium for infection, but is the same true for heparin??? and should we continue flushing with heparin because of this?
Also, are people doing "weekly" flushing for outpatients with "non-valved" PICCS with good success? and if so, what are you basing your regimens on for evidence based practice? Thanks
Patti Jo
Heparin does not decrease the risk of CRBSI. In fact, there are several in vitro studies that clearly demonstrate that heparin increases the growth of biofilm when compared to some of the other catheter locking solutions currently in the process of being studied. There is no alternative anticoagulant for catheter locking at the present time on the market in the US, but there are numerous ones being studied. I do not believe that saline alone is the total answer. There are many many issues with heparin but it is the only game in town right now. Talk to most nurses where their facility has gone to a saline only flushing procedure and ask if there use of tPA has decreased. Most state it has not. There are facilities that are reporting anecdotally that saline only is working for them, but the published evidence is going in the opposite direction. All INS members can download the webinar on this topic presented in April. The second in that series is today.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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