Heparin Flush for CVC

[astudentnurse10]

Hello,

I am a nursing student and I'm trying to find out if there are any hospitals that still use heparin to flush central venous catheters. My school teaches us to use heparin, yet none of the hospitals that I've worked at use heparin. If you use heparin at your hospital, I would love to know what state and what type of hospital (public, private, non-profit).

Thank You,

Allison

[highlandlass1592, BSN, RN]

It was 10ml normal saline before the med, but 10ml heparin when finished using the line. Thanks for catching that. I even went back and edited my post. Yes, last year was crazy. Now I am ready to get back to nursing.

Good luck to you as you begin your return to nursing. Hope things have improved for you.

[astudentnurse10]

Thanks for all the feedback. I'm just trying to find out if any hospitals still use it and what that particular hospital protocol is regarding the use of heparin to flush CVC's. I'm interested in learning the reasoning since, as stated before, the evidence based practice leans towards the use of normal saline.

I just want to get my hands on a hospital protocol that details the reasons behind using heparin over the normal saline.

Thank You

[iluvivt, BSN, RN]

The evidence only points to the use of NS on PIVs NOT Central lines. Some hospitals have decided to do away with Heparin in part due to fears of HIT. The evidence still points to the use of Heparin on all CVCs . In fact the INS got so many questions on this they made catheter care cards with their recommended flushes . They recommend using a final flush of Heparin on all CVCs (10 Units per ml) with at least 2 x the priming volume of that line. On the ports with deaccess they recommend 100 units per ml (5 ml). I have the article they used as one of their key references. When our staff gets lazy and deletes the Heparin..we spend a lot of time and money on Tpa. If you are interested I can list all of its benefits and why it is still recommended. Research is ongoing in looking for an alternate or better flush solution.

[IVRUS, BSN, RN]

It was 10ml normal saline before the med, but 10ml heparin when finished using the line. Thanks for catching that. I even went back and edited my post. Yes, last year was crazy. Now I am ready to get back to nursing.

Yes, You're welcome...

Flushing with 10 mls saline, giving the drug ordered, and then flushing again with saline helps to prevent incompatibility. The final flush would be heparin flush solution, 10 unit per ml. This is called the SASH method. Remember for Groshong IV catheters (or valved catheters) and short term peripherals, one only needs to use SAS.

Hopefully your facility policy reflects this.

[astudentnurse10]

Is there any way you could send me a link to the article, and possibly your hospital's protocol? This would help me so much, since the EBP I'm finding is only about Normal saline. Thanks!

[mama_d, BSN, RN]

The evidence only points to the use of NS on PIVs NOT Central lines. Some hospitals have decided to do away with Heparin in part due to fears of HIT. The evidence still points to the use of Heparin on all CVCs . In fact the INS got so many questions on this they made catheter care cards with their recommended flushes . They recommend using a final flush of Heparin on all CVCs (10 Units per ml) with at least 2 x the priming volume of that line. On the ports with deaccess they recommend 100 units per ml (5 ml). I have the article they used as one of their key references. When our staff gets lazy and deletes the Heparin..we spend a lot of time and money on Tpa. If you are interested I can list all of its benefits and why it is still recommended. Research is ongoing in looking for an alternate or better flush solution.

I would be interested in reference materials you have...we too are going through a lot of CathFlo, when people even bother to get the order for it. I HATE HATE HATE it when we've got a pt with a PICC or TLC that no longer functions properly and no one takes care of it. And there's been such a drive towards eliminating heparin use that people are neglecting to flush ports with it, which is an even worse issue. Nothing like jacking up a surgically implanted access.

[iluvivt, BSN, RN]

Ok I will hunt down the main reference they used

[astudentnurse10]

Can I ask what hospital you work at? The hospitals I've checked with in the Bay Area do not use heparin to flush CVCs, but they will use heparin for chest ports. I'd be interested to see the article you were mentioning because the only evidence based practice I've been able to find is systematic reviews that state inconclusive findings related to the use of heparin vs. saline for CVCs.

Thank You

[K+MgSO4, BSN]

we use NS on PICCs and TLC. We also use a device called a Clave CLC 2000 which is a positive pressure device, when using the device you do not clamp the lines off. It seems to be working well as long as staff remember not to clamp them.

[I<3H2O, BSN, RN]

I work in a rural hospital in Oklahoma and we use Heparin 100units/ml to flush CVCs. We use 1ml on each lumen and 3ml to 5ml on implanted ports.

[Jenni811, RN]

We still use heparin unless it is contraindicated in patients.

State- Wisconsin

[astudentnurse10]

Thanks I