Central Line Maintenance

[Kelly King]

Our hospital is using outdated information to maintain central lines and as a result, most are doing it in different ways. In addition to not performing it correctly, patient's often voice their concern over the inconsistency. Needing the most recent information/suggestions/policies please. Thank you.

[nrsang97, BSN, RN]

https://www.jointcommission.org/assets/1/6/CLABSI_Toolkit_Tool_3-22_CVC_Maintenance_Bundles.pdf

This is directly from Joint Commission.

[Kelly King]

Thank you!

[MunoRN, RN]

What are the inconsistencies you're seeing?

[Kelly King]

Flushing. How often? Heparin or no heparin? I read the Joint Commission statement but did not find any reference to it.

[MunoRN, RN]

2 minutes ago, Kelly King said:

Flushing. How often? Heparin or no heparin? I read the Joint Commission statement but did not find any reference to it.

Aside from manufacturers recommendations for use, which a facility isn't required to follow but are often based on at least some amount of research, evidence based consensus statements are a good source. Cochrane is about as good as it gets when it comes to drawing conclusions from all of the evidence available, for instance here is there take on heparin vs NS for 'locking':

https://www.cochrane.org/CD008462/PVD_heparin-versus-normal-saline-locking-prevention-occlusion-central-venous-catheters-adults

The frequency for flushing lines without continuous infusions is usually recommended to be q 8hrs, although the evidence to support that timeframe is weak. Probably more important than flushing frequency is flushing technique, keep in mind that a pulsatile flush is the only effective way to clear the entire cross-section of the lumen.

Keep in mind the Joint Commission is not a practice organization, they are a contractor for CMS accreditation, so they are essentially a second-hand source of practice information.

[Kelly King]

All of our nurses agree that picc lines need to be flushed Q8 when not in use but it is the others, port-a-caths, femoral lines, ej's, subclavians etc., they are mixed about. ICU does not use heparin on most, but not all of them and I have read material from a few years ago supporting that. There is nothing concrete though, thus the inconsistencies. I will look into information provided by the maker, though. That sounds like a good idea. Thank you.

[Kelly King]

MunoRN,

I just read the link you sent. Again, nothing conclusive but definitely helpful. It looks like it's up to individual facilities and/or the company that made them. :-]