Heparin Flush - 100 units/ml or 10units/ml

cardiacmadeline, RN · May 9, 2009

We flush our Power PICCs with 10 units/ml. 100 units seems like a lot.

marilynmom, LPN, NP · May 9, 2009

In PICU we flushed all (well most) central lines with 100u/ml and PIVs with 10u/ml (not all PIVs, most were saline locked but some were hep locked depending on the size and the situation). I worked at a teaching hospital/level 1 trauma center and that was our protocol.

iluvivt, BSN, RN · May 10, 2009

heparin strength varies across the country and by region as well. You will see as low as 10 units per ml all the way up to 1000 units per ml....For example at my hospital job we use 10 units per ml on all CVCs,including PICCs and excluding ports (which is 100 units per ml). At my home care IV job we use 100 units per ml on everything...even PIVS. There is no consensus on the stength...but studies have shown that on CVCs...it still does reduce occlusion rates. PIVs are a different story and the research shows that NS is equally as good as NS...so why pay for the heparin and get no benefit. Some healthcare facilities opt for the 100 units per ml on PICCs b/c they are generally a longer line and are most likely selecting that strength to reduce their occlusion rates. HIT only affects about 2% of the population with HIT 2 being the worst

creo · May 10, 2009

In PICU we flushed all (well most) central lines with 100u/ml and PIVs with 10u/ml (not all PIVs, most were saline locked but some were hep locked depending on the size and the situation). I worked at a teaching hospital/level 1 trauma center and that was our protocol.

How many mls of each do you use?

SharonH, RN · May 10, 2009

PIVs are a different story and the research shows that NS is equally as good as NS...so why pay for the heparin and get no benefit.

Good question. I'm surprised to read that anyone anywhere is routinely flushing a PIV with Heparin.......I haven't used Heparin on a PIV for over 15 years.

mama_d, BSN, RN · May 10, 2009

We don't get to flush either with heparin, just NS. At my facility pretty much only ports get heparin flushes, I believe off the top of my head it's 100 units/mL.

Of course, if I can't get any blood return and there's no history of HIT or heparin allergy, I've been known to throw some heparin in there to sit awhile and come back later to see if it fixed the problem....

nminodob · May 10, 2009

I think it depends as well if the port is fitted with an anti-reflux valve, which has positive pressure and prevents backflow. All our IVs (including central lines) have these valves and we never use hep flushes, only NS. However, I have run into many that are clogged, so I wonder if some nurses aren't even using the NS to flush!

mama_d, BSN, RN · May 10, 2009

I think it depends as well if the port is fitted with an anti-reflux valve, which has positive pressure and prevents backflow. All our IVs (including central lines) have these valves and we never use hep flushes, only NS. However, I have run into many that are clogged, so I wonder if some nurses aren't even using the NS to flush!

We have some PICCs that have the valves and some that have clamps, not sure why...both are same manufacturer, I think it's just whichever ones the hospital got the best deal on that month. Anyway, I have noticed that those with the valves instead of clamps consistently clot off or fail to give blood return in greater numbers. Regardless of the nurses I follow.

marilynmom, LPN, NP · May 10, 2009

How many mls of each do you use?

1-2 mls for a PICC or other central line to lock it depending in the size of the child (infant vs 22 yr old so it really varied).

I should clarify that we did not routinely lock PIVs with 10u/ml hep but in some circumstances we had....They are almost always NA locked, but I have had a few that were hep locked per MD order so that is why I mentioned that---though I found it strange and quit odd.

I haven't worked in that unit since January but wanted to mention our protocol when I did work there. Not saying I agree with it, but that was the written protocol.

Nurses really have to be on the ball with implementing EBP in their unit. When I first started working in that PICU (about 2 years ago) they were still using saline to flush down ETT before suctioning.....all the RNs were doing that because that was how it has always been done. Myself and the other new grads started bringing in research articles on how that is EBP to our nurse educator (infection, it hurts the patient, etc) and us new nurses were able to help transition our unit away from that practice. Even though our nurse educator knew about saline not being good for ETT suctioning she was having a hard time really educating and changing all the nurses who worked for that unit (100 RNs total inclusing pt, prn, float, ft, etc). Some practices are just habits no longer backed in evidence based practice.