Flushing a Port-a-Cath--to waste or not to waste?

Virgo_RN, BSN, RN · Jul 21, 2009

Our protocol is to just flush it through.

blondy2061h, MSN, RN · Jul 21, 2009

I see no reason to waste. We also just flush through.

EymieICURN · Jul 21, 2009

Check your Hospital Policy. The policy where I work is that you waste 5-10 ml (depending on catheter size) before flushing if the catheter has Heparin. Yes, the Heparin dose is really small, but there is something called Heparin Induced Thrombocytopenia(HIT). HIT is an allergic reaction to Heparin that can be deadly, so why exposed the patient to more Heparin that we have to.

luvbug9956 · Jul 21, 2009

I draw back to check for blood return anytime I access a port. When I do that, I just go ahead and waste 3-5 cc's. I want to know that I am flushing into a patent line!

iluvivt, BSN, RN · Jul 22, 2009

No you do not need to waste any blood unless you are drawing a sample and there is no current recommendation from INS to do so......just draw back a little to verify a brisk blood return.....wasting can also can trap blood in the y site on a lot of of port extension sets the no one ever seems to flush out ( I do),and it just sits there potentially increasing chance for infection....Oh..the HIT thing....really only effects 1-2 percent of the population and there are two kinds...1st kind just stop the Heparin and platlets come back up...second kind is way more troublesome.....but honestly....I do not think wasting heparin that has been sitting in a port will change the numbers...if patients platlets are low...the cause needs to be investigated and heparin ruled in or out....the risk for infection and occlusion is far greater than the HIT ....now with some of the long term dialysis catheters and some of the short term ones...you do waste as the Heparin doses are much larger l

bruinrn · Jul 22, 2009

Thanks for the great replies everyone. I knew I came to the right place to inquire!

To ILUVIT: how much heparin is conisdered "a large dose"? Thanks.

EymieICURN · Jul 22, 2009

Once again....Make sure you follow the policy at your facility...Even if the chance of HIT is only 1%, if it happends to your patient and you did not follow hospital policy you may find yourself in trouble. Bottom line, I would make sure to follow that policy to cover yourself!

IVRUS, BSN, RN · Jul 22, 2009

Regarding HIT,

HIT is an antibody-mediated reaction which occurs after anti-platelet antibodies are created from a previous exposure to heparin. HIT is NOT dose-dependant - that means that one does not have a greater possibility of developing the disorder if they get 100units/ml heparin vs 10units/ml.

Hope this helps!

blondy2061h, MSN, RN · Jul 22, 2009

Regarding HIT,
HIT is an antibody-mediated reaction which occurs after anti-platelet antibodies are created from a previous exposure to heparin. HIT is NOT dose-dependant - that means that one does not have a greater possibility of developing the disorder if they get 100units/ml heparin vs 10units/ml.
Hope this helps!

If it's not dose dependent, it won't matter if a waste is drawn or not.

We've stopped flushing all central lines except IVADs with heparin because of this.

iluvivt, BSN, RN · Jul 23, 2009

The tunneled dialysis catheters are flushed here with 5000 units of heparin (0.5ml of 10,00 units per ml mixed with 1.5 ml NS for a total volume of 2 ml...the discard is not to prevent HIT though...it is just discarded to prevent overflow of large dose of Heparin b/c of it anticoagulation effects.....Oh the heparin use vs not using it....studies do show a decreased rate of thrombosis and occlusion when Heparin is used on all types of CVCs and many studies suggest that its use also may decrease the risk of catheter related blood stream infection...its antimicrobial activity may be due to the preservative in heparin......so you see the dilema...reduce HIT..but increase occlusion.thrombosis and possibly infection...I say infection and thrombosis and occlusion are bigger problems.....so we only get to use heparin for HD catheters and ports?...so if is good enough to use to decrease the risks to the patients on those lines..How come not all CVCs?..just throwing some ?s out there.....perhaps all those researchers out there will come up with a viable alternative...I pray for it!!!!