best practice for CVC flushing?

[pacnwRN]

Wanting to get some information on the protocol at your facilities on CVC flushing. I just started at a new facility and the protocol here is different from where I previously worked.

Wondering how often you flush with heparin vs. how often you use saline?

[Five&Two Will Do]

It depends on whether or not there are continuous infusions or just IVP & IVPB. If I have a triple lumen or a PICC, it depends on the infusions. If they have one port with cont IVF, I will flush that port with saline using a good push/pull method to ensure good blood return and no build up at the tip. The other ports(PICC) I will flush and heparinize once per shift or after any IVP or PB that I give. We went to a clampless type of PICC for a while, called SOLO, that used saline only, but they were trash. I had never given so much cathflo before then. We stopped using them after about 6 months. Unless vet is at high risk for developing HIT, or has some other type of coagulopathy, that little bit of heparin per port is not gonna hurt them once per shift ie, 8-12 hours.

[xadnder]

I was under the impression, though not actually done the research, that evidence has shown that in terms of PICCs, a good turbulent flush of NS and checking for adequate blood return every 8 hours is just as effective for maintaining patency as heparinizing. A Port would need to be packed since it has a tiny pool of blood at the port site. This is my facility's policy and, while we of course use CathFlo from time to time, it seems to be effective and more ideal than infusing heparin after every push.

[Five&Two Will Do]

I was under the impression, though not actually done the research, that evidence has shown that in terms of PICCs, a good turbulent flush of NS and checking for adequate blood return every 8 hours is just as effective for maintaining patency as heparinizing. A Port would need to be packed since it has a tiny pool of blood at the port site. This is my facility's policy and, while we of course use CathFlo from time to time, it seems to be effective and more ideal than infusing heparin after every push.

The patho behind the heparinization depends upon whether the line is a positive or negative pressure line. The SOLO PICC is a positivepressure line that theoretically does not allow any blood reflux after a flush. I say theoretically because we continued to have clottin at the catheter tips. Lines with clamps are not positive pressure so they allow a scant amount of blood to migrate into the tip. The idea of the heparin is toprvent said blood from clotting. Since the line is not positive pressure, the blood pressure of the body will keep the heparin in the tip of the catheter promoting its efficacy. Maybe its just overkill however and we were just not flushing turbulently enough. Either way, that is the procedure where I work.

[classicdame, MSN, EdD]

The Infusion Nurses Standards of Practice do not recommend heparin on routine flushes, due to higher incidences of HIT. Volume should be about 2 times the volume of the lumen, which is MUCH smaller than you think. Look at the package for details.

[wooh, BSN, RN]

It's all going to depend on the type of CVC, the brand used, the size of the lumens, etc.

[pacnwRN]

The Infusion Nurses Standards of Practice do not recommend heparin on routine flushes, due to higher incidences of HIT. Volume should be about 2 times the volume of the lumen, which is MUCH smaller than you think. Look at the package for details.

This was the thinking at the facility I previously worked at. Coming to a new facility where they literally flush with heparin after every IVP and infusion in any PICC or Central line seemed like overkill to me. It's amazing how different one facility is to the next!