Flushing PICC & Central lines with Heparin?

[KacyLynnRN]

They recently started a new policy at my hospital that PICC lines and Central lines are no longer to be flushed with any Heparin, only NS. The reason why hasn't really been explained, only that it is a policy change. I have heard talk that it is interfering with pt.'s blood clotting, and/or it is some new JACHO regulation. Anyway... we have had a lot of these lines clot off recently. (BIG surprise!) and I was wondering if any other hospitals have enacted the same policy, and/or if anyone has heard a reason why PICC lines and Central lines should no longer be flushed with Heparin holding solution.

[CapeCodMermaid, RN]

Our pharmacy policy is still to flush PICC lines with NS and 100u Heparin. I worked at one place as the SDC and the nurses kept telling me their PICC and Mid lines were forever clotting. I reviewed the protocol and found they were using 2cc of 10u Heparin. I discussed it with the medical director and we changed the protocol to 3-5cc NS and 3cc 100u Heparin...not one has clotted off since then. Then only time we might back off the Heparin would be if someone had an antibiotic q 4.

[leslie :-D]

i know where i worked there were nurses flushing peripheral lines w/heparin 100u and picc/central lines w/heparin 10u....in other words they weren't reading which was which....i'm grabbing at straws here.....

[memphispanda, RN]

We use saline flushes only for central and PICC lines. The only time heparin is used is for unused lumens of Hickmans, deaccessing PACs, etc. There have been multiple reasons given for this including heparin allergy, interference with clotting, etc. We don't seem to have many problems with lines clotting off lately (like the last 3 months) because most people are flushing with 20cc saline instead of just 10.

[BittyBabyGrower, MSN, RN]

The only time we use hep flushes is if the line is capped off. If it has a constant infusion going we only use NS flushes.

[NeuroICURN]

I didn't know anyone still flushed with heparin anymore!!! I thought that was pretty archaic?!

Anyway, from the literature that I have read on the subject, there really is no true difference between flushing with NSS and with Heparin, despite what previously thought. As for clotting PICCs, well, if they clot off then we use cath-flow....that stuff is wonderful!!! I've never had any other central get clotted off, but then again, we're all very diligent in flushing with 10mL at least every 8 hours (not saying any of you aren't, just that I've never had it happen).

The only thing we still infuse heparin through (other than if they're on a heparin gtt) is if they leave a femoral sheath in after angio.

That's my 2 cents.

[RN92]

There are many different kinds of picc lines. Groshongs, for instance, dont require heparin at all. Other picc lines have special valves that keep + pressure and dont need heparin. I too, have read many articles that say there is no real benefit to heparin flushes. You do have to flush the lines with more than just 2-3ccs of NS - especially if you are drawing blood samples through them. FYI: make sure you use at least a 5cc syringe when flushing picc lines. If you use one smaller - it can ruin your picc line.

[circa68]

We are still archaic where I work. our policy is 10 of nss 100 units of heparin q 12 hours for capped piccs, centrals. However as a nursing measure any pt with a low platelet count or history of HIT just gets 20 of nss.

[Farkinott, RN]

We don't flush with heparin but use heparin locks which are withdrawn and discarded before flushing with n/saline when the catheter is accessed. When therapy is done the catheter lumen is again flushed with saline and locked off again with heparin 5000mg/ml.

[Gompers, BSN, RN]

We always have heparin mixed into our IV bags that are going into either PICC lines, Broviacs, umbilical catheters, or peripheral arterial lines. We usually use 0.5 units/ml in maintenence fluids and 2 units/ml for saline TKO continuous infusions. We have fluids constantly running through all of the above mentioned lines except for Broviacs. We'll either have a double lumen where one port is used only for blood draws or incompatible meds, and this port gets a heparin flush 3 times a day - or we'll have a single lumen Broviac and turn off the IV fluids for a few hours a day to cycle the TPN, and when we do that we'll instill a heparin flush at that time as well. We use 10 units/ml of heparin/saline solution, about 3 ml. But don't forget that our lumens are tiny in NICU and run more of a risk of clotting off.

If we suspect a heparin allergy we do a blood test to rule it out and DC all heparin (and take our chances) if the patient is indeed allergic.