[rose28164]

My hospital has a protocol to flush triple lumen caths with 2.5cc of heparin, divided among three ports. So I followed the protocol and flushed. Then the next night I was off and laying in bed and remembered that the pt was switched from heparin to lovenox that previous morning. I have not been to work since and am wondering if this would be a problem. Any advice????

[NurseStacey143]

flushing with lovenox? Never heard of it. Our flushing protocol is flush with 5 cc NS then 2 cc Hep.

[rose28164]

Originally Posted by NurseStacey143

flushing with lovenox? Never heard of it. Our flushing protocol is flush with 5 cc NS then 2 cc Hep.

No, the protocol is flushing with heparin, but my concern is that the pt was getting lovenox inj. and I flushed their ports with heparin.

[chickie]

You flush each port with heparin to keep them patent. The lovenox administered sc in the abdominal area is used as a blood thinner to prevent blood clots, don't put the lovenox into the central line. Out central line policy is to flush each port with 5cc of normal saline followed by 2.5cc of heparin in each port and always use a 10cc syringe in the central lines.

[rose28164]

Originally Posted by chickie

You flush each port with heparin to keep them patent. The lovenox administered sc in the abdominal area is used as a blood thinner to prevent blood clots, don't put the lovenox into the central line. Out central line policy is to flush each port with 5cc of normal saline followed by 2.5cc of heparin in each port and always use a 10cc syringe in the central lines.

I was just concerned because I know your not suppossed to give a combo of heparin and lovenox, or coumadin........basically any combo of blood thinners.

[apaisRN]

The small amt of heparin used as a flush does not usually have a systemic effect. Don't worry about it.

OTOH, my hospital no longer uses heparin flushes, except in dialysis catheters. When a patient has HIT even a flush can be a problem. We flush with saline. If a line gets clogged we use TPA to clear it, but you just put the TPA in and aspirate later, you never actually push the TPA into the patient.

[apaisRN]

Also, I often have patients therapeutic on heparin while working up to a therapeutic INR with Coumadin. It's not unusual to be on both, briefly.

[heart queen]

the small amount of heparin that you are flushing in the catheter for patency will stay in the catheter, assuming that you withdraw a 5 or 10 cc discard and flush with NS prior to med administration or blood draw, the amount depends on policy.

The lovenox is for DVT prophylaxis period, due to immobility or a high risk patient. The heparin in the line does not meet the patient and will not give any anticoagulation protection for the patient. It is completely safe to do both.

You would never have a patient on both SC heparin and lovenox or IV heparin and SC lovenox... this is what would cause concern.

hope this helps.

[rose28164]

Originally Posted by heart queen

the small amount of heparin that you are flushing in the catheter for patency will stay in the catheter, assuming that you withdraw a 5 or 10 cc discard and flush with NS prior to med administration or blood draw, the amount depends on policy.

The lovenox is for DVT prophylaxis period, due to immobility or a high risk patient. The heparin in the line does not meet the patient and will not give any anticoagulation protection for the patient. It is completely safe to do both.

You would never have a patient on both SC heparin and lovenox or IV heparin and SC lovenox... this is what would cause concern.

hope this helps.

YES!!!!!!!!!! This helps. I am a new grad (well a nurse of 7 months) and I am usually so carefull with what I do. I have been worring about this for days! I just dont want to get written up or get my liscence taken away.

[Tweety]

Good advice here. Glad you learned something.

I might add that you will see patients recieving two blood thinners at once sometimes. Especially if someone is on a heparin drip and they are trying to find a coumadin dose that is therapeutic. They will be on the heparin and taking coumadin at the same time. :hatparty: