Cordis/Introducers

sunnycalifRN · Apr 16, 2011

"Locking off" the cordis? Please explain. In my unit, PA cath is DC'd and the cordis is left for our use until we transfer the patient to the stepdown unit. We usually DC the cordis prior to transfer.

kc4nrsng · Apr 16, 2011

We do that as well. However before they transfer do you stop running fluid through it?

MunoRN, RN · Apr 16, 2011

It's not often that an open heart doesn't have something running, but on the tele floor I used to work on, all of our hearts still had their cordis in place and usually without any fluids running continuously. (AACN recommends introducers only remain in for patients with a 1:2 ratio and we were 1:6 but that's a different issue). We would just saline lock them, I've never seen one occlude although by day 4 or 5 they usually don't draw any more.

sunnycalifRN · Apr 16, 2011

We do that as well. However before they transfer do you stop running fluid through it?

I understand what you mean. Before we can DC the cordis, we have to have two good peripheral IV's. So, usually, any drips have been switched to the peripheral IV's or a PICC. If we're still running a pressor that shouldn't run peripheral, we can't DC the cordis. But, if we're running a pressor, we won't transfer the patient anyway.

Biffbradford · Apr 16, 2011

Like a heparin lock? or capping with sodium citrate? Is that what you're after?

kc4nrsng · Apr 19, 2011

Yes like a heparin lock w/o the heparin. For example; on post op day one morning we will stop running fluids and saline lock the cordis to take the patient for a walk and then not restart any fluids as most of the time they will transfer to tele once the surgeon or the PA has rounded and written orders. Sometimes the patient might not be able to transfer for one reason or another but they don't need fluid running; in those situations we have been under the impression that they shouldn't be left saline locked. We have an order post operatively to TKO fluids when patient is taking po fluids well. Usually they can't get enough; but we only run the fluid at 30ml/hr anyway. It seems like there is no evidence-base practice out there.?

TakeBack · Apr 20, 2011

Yes like a heparin lock w/o the heparin. For example; on post op day one morning we will stop running fluids and saline lock the cordis to take the patient for a walk and then not restart any fluids as most of the time they will transfer to tele once the surgeon or the PA has rounded and written orders. Sometimes the patient might not be able to transfer for one reason or another but they don't need fluid running; in those situations we have been under the impression that they shouldn't be left saline locked. We have an order post operatively to TKO fluids when patient is taking po fluids well. Usually they can't get enough; but we only run the fluid at 30ml/hr anyway. It seems like there is no evidence-base practice out there.?

If they are taking PO, have a PIV, and don't have infusions running then just take the line out.

kc4nrsng · Apr 20, 2011

Amen.. we are trying to get out surgeons to add to post op orders

JF808Rn · May 28, 2011

saline lock should do it w/ a flush @ every shift change. at least that's SOP at my facility.

CABG patch kid, BSN, RN · Jun 12, 2011

I'm not sure if your concern is stemming from the cordis clotting off or it being a source of infection, but either way, we have had several patients who still have their cordis, saline locked, with no current IVF running. Reason being, in our order set we can leave the cordis in until Vancomycin is d/c'd (48hr post op) and for KCL infusions. Often times, the pt is not getting a maintenance fluid because our docs worry about fluid overload in our post op valve pts. Sometimes we leave until we get a PICC or the doc will order to d/c it post op day 1. It all depends on the pt. We do strive to get central lines out asap to prevent central line associated blood stream infections.