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heparin 2 units flush

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I am a new grad in the nicu. to keep the peripheral line patent an order for 2 units in PF NaCl 0.45% 10mL vial .3-.5 mL IV lock Flush to peripheral line's ordered. Do I or do I not need to mix the heparin with equal parts of normal saline. for example if I use .3 hep then i would also put in .3 normal saline into the syringe and then flush the peripheral line??

if it's the med line on a UVC do I still dilute the hep equally with normal saline? then should i follow that with a 1 mL flush of NS or not?

NIGHTWOLF87

Specializes in NICU, Psych, Med/Onc,Ped Home Health. Has 6 years experience.

we flush our peripheral line heplocks with each of our touch times (q 3-4hrs, usually), and we use pre-mixed flushes of 1/2ns with heparin 1:1.

as far as as the med line on a uvc, again, we use pre-mixed heparin flushes and run it at 0.2ml/hr continuously to keep the line patent.

do you have to mix your own flushes with heparin and ns? our pharmacy sends up ours already pre-mixed.

Not for nothing, but heparin flushes have not been proven as beneficial to maintaining the patency of a perpherial line. Many institutions have discontinued it's use for it after some sentinal events nationwide. There are several journal articles and studies that you can present to your clin spec, NM and depatment head so you can hopefully convince them to discontinue this potentially dangerous practice

littleneoRN

Specializes in NICU. Has 6 years experience.

I believe there was a Cochrane review done suggesting that heparin flushes are no more effective than saline. But to respond to the OP, I think you need to check your facility's flush policy as every place does something different with this. I would not personally think you'd follow a heparin flush with a saline flush as this would displace the heparin from the line, defeating the purpose. But find out your policy...and talk to experienced co-workers. :)

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

check your policies. We only use saline on peripherals, and prefilled hep flushes for our centrals.

300g

Specializes in NICU III/Transport. Has 9 years experience.

i am a new grad in the nicu. to keep the peripheral line patent an order for 2 units in pf nacl 0.45% 10ml vial .3-.5 ml iv lock flush to peripheral line's ordered.

if this was a written order, it reads to add 2 units heparin to 10ml 1/2ns vial (or use a prefilled 2 units heparin per 10ml 1/2ns --- 0.2 units heparin/ml 1/2ns)... then withdraw 0.3-0.5ml to use to flush.

do i or do i not need to mix the heparin with equal parts of normal saline. for example if i use .3 hep then i would also put in .3 normal saline into the syringe and then flush the peripheral line??

i can't imagine that this is your units policy. that's how babies get 300-3,000 units of heparin by "accident". if you used the lowest concentration heparin vial available (10 units/ml) you'd be giving 3 units of heparin and that's the highest concentration i've ever heard of in neonates.

if it's the med line on a uvc do i still dilute the hep equally with normal saline? then should i follow that with a 1 ml flush of ns or not?

in all honesty, your question sounds like you might not completely understand the purpose of flushing lines with heparin or the volumes required for each type of line in your facility (they vary). you should really bring this question to your preceptor or more experienced nurse so they can explain to you. also, review your units policy/procedure and if this is an isolated/exceptional order, clarify with the person who wrote it.

i don't like answering this type of question online as you may not have supplied all the information necessary for a complete and accurate answer. this can be a very dangerous situation for your patients! please ask your coworkers this question!

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

If I read this right, you have a VIAL of heparin, not prefilled syringes? I didn't think units were allowed to keep vials anymore since there have been several sentinal events in the past year.

You need to ask instead of risking your license and your patient's life, you can easily overdose with heparin doing what you say you are doing.

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

This flush order you mentioned sounds extremely complicated and dangerous. The potential for overdosing your patient is enormous!

I would speak to your nurse educator or manager about reviewing the data on peripheral IV patency management. Heparinized saline has been shown to be no more effective at maintaining PIV patency than plain normal saline.

http://findarticles.com/p/articles/mi_m0FSZ/is_n2_v24/ai_n18607769/?tag=rbxcra.2.a.11

Here we are never allowed to add heparin to anything. Heparin has been labeled a high-risk medication by JCAHO. Pharmacy mixes up all our heparinized solutions, and we draw flush off a 1u:1ml [either NS or d5%] 50cc bag for UACs. PALs are never flushed, and we use NS on saline locks. We flush those once or twice a shift. Although if a baby doesn't get IV meds, that IV is OUT.

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