Central Lines???

Nurses General Nursing

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I realize every facility does things differently, but how do you all flush central lines? Some say to put 5 cc's of saline in a 10 cc syringe, flush and follow with heparin. Others don't use heparin. Some require or allow prefilled syringes with saline and heparin mixed. I have a mental block when it comes to flushing central lines. We have a chart, but even finding out which line someone has can be an obstacle! When I question other nurses many seem to not be 100% sure. Thanks for your help!

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Specializes in ICU, ER.

In our er, we have a detailed protocol for each type of line. In actual practice, it's usually just a big shot of NSS.

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Central lines and ports I always flush with at least 5ml of heparin after flushing with NS. I don't want to take any chances of the line clotting off so I am anal about using heparin with these lines.

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Specializes in Cardiac.

NS only.

The only thing I use heparin on are open-ended PICCs.

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Specializes in Internal Medicine.

HI,

I am from Canada so can't speak to the rules in the US, but I would be surprised if there wasn't a strict policy at your facility as to how to do this. You mention a chart and this is what I would go with as long as it is from your procedure/policy manual. I have learned (especially while being in nursing education recently) that it is NEVER a good idea to trust word of mouth when it comes to your own practice. Using more heparin, for example, than is indicated in your policy for a certain line could end up with you in court if that pt were to bleed out and found to have a high PTT. Stick with the hospital policy. If you are unsure as to what type of line you are accessing don't access it until you are sure. That is my best advice.

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Specializes in Psychiatric.

We have a chart too in our med room which is a blown-up copy of the page from the policy/procedure manual dealing with the flushes, since there are different protocols for flushing PICCs versus the Power PICCs versus Ports...I have to look at it a LOT!

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

The Infusion Nursing Society has great central line care and flushing recommendations.

In addition, many facilities are now recommending JUST NS for lines, as opposed to heparin....in evidenced based studies, if the line has positive pressure caps in place, there is no increased incidence of clotting than the use of heparin. Heparin is fast becoming one of the most "allergic" reaction type drugs, inducing Heparin Induced Thrombocytopenia or HITT. People can develop such severe coagulopathy problems, that they have permanent platelet suppression and subsequent bleeding disorders. It is now recommended that Heparin be used only in VasCaths...dialysis catheters and limited amounts in some centrally tunneled catheters....otherwise, a straight simple triple lumen catheter can stay unclotted with just normal saline....provided you have the positive pressure caps and you flush them every eight hours.

Here's a website for ya:http://www.INS1.org.

here's one hospital's grid for heparin usage in lines:

http://www.chsd.org/documents/Staff%20Development/central_line_care_table.pdf

http://www.bardaccess.com/misc-faq.php

Hope this helps clear up the muddy waters of flushing...:wink2:

crni

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Specializes in SNF.

Think about why you are flushing the line......5 ml will barely get you from the port to the vc. 10 ml makes more sense to actually get the medicine through the cath and into the vasculature. The line is long enough, it warrants 10ml.

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HI,

I am from Canada so can't speak to the rules in the US, but I would be surprised if there wasn't a strict policy at your facility as to how to do this. You mention a chart and this is what I would go with as long as it is from your procedure/policy manual. I have learned (especially while being in nursing education recently) that it is NEVER a good idea to trust word of mouth when it comes to your own practice. Using more heparin, for example, than is indicated in your policy for a certain line could end up with you in court if that pt were to bleed out and found to have a high PTT. Stick with the hospital policy. If you are unsure as to what type of line you are accessing don't access it until you are sure. That is my best advice.

I agree. Every facility has their guidelines and protocols, and expects every employee (doctor, nurse, tech, etc.) to follow them. Doing it "your own way" or even according to the Infusion Nursing Society can get you into deep trouble if you are called into a courtroom.

Follow the hospital's written protocols. They are there to CYA as well as the Hospitals.

Cheers,

Michael ;)

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NS only here due to HIT and heparin allergy

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Specializes in PEDIATRICS.

Just Want To Know If Anyone Knows Of A Web Site On Information On Ports. Any Onfo Would Help. Thx :)

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Specializes in Trauma ICU.
Think about why you are flushing the line......5 ml will barely get you from the port to the vc. 10 ml makes more sense to actually get the medicine through the cath and into the vasculature. The line is long enough, it warrants 10ml.

Actually, 5cc is enough to flush a central line.

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