Central Lines???

  1. 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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    About lisa41rn

    Joined: Mar '05; Posts: 166; Likes: 42

    20 Comments

  3. by   bill4745
    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.
  4. by   TazziRN
    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.
  5. by   cardiacRN2006
    NS only.

    The only thing I use heparin on are open-ended PICCs.
  6. by   bren3299
    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.
  7. by   EarthChild1130
    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!
  8. by   CRNI-ICU20
    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:www.INS1.org.

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

    http://www.chsd.org/documents/Staff%...care_table.pdf

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

    Hope this helps clear up the muddy waters of flushing...:wink2:
    crni
  9. by   TeresaB930
    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.
  10. by   msdobson
    Quote from bren3299
    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
  11. by   meandragonbrett
    NS only here due to HIT and heparin allergy
  12. by   evaruth
    Just Want To Know If Anyone Knows Of A Web Site On Information On Ports. Any Onfo Would Help. Thx
  13. by   TraumaICURN
    Quote from TeresaB930
    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.
  14. by   TXstudentRN
    Quote from evaruth
    Just Want To Know If Anyone Knows Of A Web Site On Information On Ports. Any Onfo Would Help. Thx
    This is a great website with LOTS of links to all kinds of lines and ports: http://www3.nbnet.nb.ca/normap/ivaccess.htm. It's technically for patients with CF but is a fantastic resource. I can't remember if I got it from someone on here or found it on my own while researching, but it's definitely on my favorites!

    What about when you're flushing a port before deaccessing it? We (meaning me and my nurses - I'm port-ed) always use 10cc NS and 5cc heparin before taking out the needle. I heard some places are just doing NS on those too, but it kind of scares me to not have heparin in there if it's deaccessed for awhile, especially if it's only being flushed for maintenance once a month...

    It really is amazing how every nurse has his/her own way of dealing with central lines - when you get into homecare it gets even MORE crazy - I think every nurse I've had did something a little different (especially when it gets to dressing changes too) and they're all from the same place. Not that any of them are wrong (haha I'd point that out in a heartbeat), it's just funny how many different ways there are to reach the same result!

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