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Heparin Flush for CVC

Nurses   (12,088 Views 27 Comments)
by astudentnurse10 astudentnurse10 (New Member) New Member

603 Profile Views; 8 Posts

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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

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CCL RN has 10 years experience as a RN and specializes in Cath Lab/ ICU.

557 Posts; 11,691 Profile Views

We use heparin unless contraindicated...(hospital)

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divaRN* specializes in ICU, medsurg/tele.

85 Posts; 3,164 Profile Views

we recently stopped using heparin flushes for PICC and CVC lines. The only line we use them for is a chest wall port. All of our PICC and CVC lines have a special coating on them to prevent clotting.

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8 Posts; 603 Profile Views

CCL RN,

Can you tell me what hospital you work at? I'm trying to find a hospital that uses heparin, in order to see what their policy/procedures are around flushing CVC lines.

Thank You

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8 Posts; 603 Profile Views

CCL RN,

Can you tell me what hospital you work at? I'm trying to find a hospital that uses heparin, in order to see what their policy/procedures are around flushing CVC lines.

Thank You

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cwhitebn specializes in General Surgery, Orthopaedics, ICU, ER.

42 Posts; 1,394 Profile Views

We use saline for our PICCs and heparin flush for the triple lumen CVP lines (hospital)

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379 Posts; 5,463 Profile Views

It's actually quite rare to find places that use heparin these days. From what I understand case studies have shown that using heparin to hep-lock vs 0.9NS has no advantages and can actually be very bad for a patient if the line is FLUSHED without aspiration, especially in those patients with coagulable states (this is what *I* learned in school). The disadvantage to 0.9NS is that in order to maintain patency you must flush Q12 or Q8 with a predetermined (10ml typically) amount of saline. I have never worked at a heparin-using facility, so I don't know if those people have to flush in the same fashion or not.

Finally, all of our dialysis catheters are "locked" with Sodium Citrate now. I am not 100% familiar with this anticoagulant as the dialysis RN's are the ones that dwell the med in the catheters, however from what they have told me is that unlike heparin, when it's disseminated in the blood stream (aka if it was inadvertently flushed through the catheter before aspiration on accident, or if the med was unable to be removed via aspiration), it inactivates nearly instantly so there's little to no bleeding risk. I don't know if this is the truth, but from what they've said this is the reason they've made the switch. ... It keeps the line anti-coag'ed so it remains patent, but also is lower risk than 10k unit dose of heparin.

Ps- I'd use your school's CINAHL access to see if you can find the studies I'm referencing. I no longer have CINAHL or I'd try to do it myself.

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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

1,021 Posts; 20,260 Profile Views

All catheters over 3 inches in length that are NOT valved, should have heparin flush solution, ideally the lowest concentration 10 units/ml to prevent occlusions. There really isn't any other "locking" solution available in the USA at this time.

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Daliadreamer specializes in Oncology, LTC.

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We just use a heparin flush when we discontinue chest wall ports.

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OrionQuiltsRN has 3 years experience and specializes in Med-Surg.

45 Posts; 2,143 Profile Views

Depends on the type of central line being used. Last year during my cancer treatments I had a double lumen central line in my chest, a double lumen Groshong in my left arm, and a double lumen Power PICC in my right arm.

The Power PICC is an open-ended catheter and was flushed with heparin (per manufacturer's instructions) EACH and EVERY time it was accessed; 10ml heparin before any med and 10ml after any med including infusions. Heparin had to be used even after daily blood draws. The tip of an open-ended line will clot off otherwise. Even with this care, a fibrin sheath did develop which was challenging to reopen.

My other two lines had a closed tip on them, and could be flushed with 10ml normal saline ONCE A WEEK. The closed tip helps protect it from clotting.

There were several ER admits and out-patient blood transfusions for me last summer. I had kept the manufacturers instructions to share with those nurses because not all of my nurses understood that the Power PICC needed heparin with every access to the line.

Always check with the manufacturer as well as hospital policy.

Edited by OrionQuiltsRN
additional info

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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

1,021 Posts; 20,260 Profile Views

Depends on the type of central line being used. Last year during my cancer treatments I had a double lumen central line in my chest, a double lumen Groshong in my left arm, and a double lumen Power PICC in my right arm.

The Power PICC is an open-ended catheter and was flushed with heparin (per manufacturer's instructions) EACH and EVERY time it was accessed; 10ml heparin before any med and 10ml after any med including infusions. The tip of an open-ended line will clot off otherwise. Even with this care, a fibrin sheath did develop which was challenging to reopen.

My other two lines had a closed tip on them, and could be flushed with 10ml normal saline ONCE A WEEK. The closed tip helps protect it from clotting.

There were several ER admits and out-patient blood transfusions for me last summer. I had kept the manufacturers instructions to share with those nurses because they were not quite willing to believe that the Power PICC needed heparin with every access to the line.

Always check with the manufacturer as well as hospital policy.

I'm sure you meant 10 mls Normal saline before and after each medication, and then the locking solution was with Heparin flush solution. Wow, So sorry that you had so many different types of IV catheters in one years time. And, yes, POWER PICC's do occlude with great frequency and they need to be heperinized.

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OrionQuiltsRN has 3 years experience and specializes in Med-Surg.

45 Posts; 2,143 Profile Views

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.

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