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Implanted Ports & Heparin Flushes

Oncology   (6,905 Views 17 Comments)
by HMarie13 HMarie13 (New Member) New Member

HMarie13 has 5 years experience and works as a Vascular Access Nurse.

2,617 Visitors; 40 Posts

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Hello everyone! I wanted to get information on others policies...I have found some online but thought this would also help. I have to update our flush protocols and need to know what other hospitals do and have articles to back it. So far I have found nothing in INS but I am still looking. Any other places good to check?

When accessing an implanted port, do you waste the first 5mL of blood removed to discard the old heparin or check for blood and flush the line?

How often do you flush with heparin?

Every 12 hours?

After medications through out the day?

After blood draws? Contrast?

Thanks for any responses! Our educators are skittish because of HIT and don't think we should use heparin.

I asked our sales rep for the port brand we use and they suggested "per hospital policy" :facepalm:

Edited by HMarie13

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Maritimer has 20 years experience.

9 Likes; 5,368 Visitors; 26 Posts

I haven't flushed routinely with heparin in a long time due to HIT--we generally just use saline with our Groshong ports unless we have had clotting issues, in which case we will add low-dose heparin. We do still use heparin flushes on our non-Groshong tunneled catheters and PICCs. Not sure where to find an article, though; our policies don't have resources cited.

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1,692 Likes; 4 Followers; 17,008 Visitors; 2,526 Posts

When accessing an implanted port, do you waste the first 5mL of blood removed to discard the old heparin or check for blood and flush the line? No, it isn't necessary unless you are drawing labs

How often do you flush with heparin? Only when de-accessing the port.

Every 12 hours? No

After medications through out the day? 10 ml Normal Saline

After blood draws? 20ml Normal Saline

Contrast? 10ml Normal Saline. If dual port flush both sides.

Hope this helps.

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HMarie13 has 5 years experience and works as a Vascular Access Nurse.

2,617 Visitors; 40 Posts

Yes thank you Wuzzie. I am just trying to get of feel of how others utilize heparin.

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HMarie13 has 5 years experience and works as a Vascular Access Nurse.

2,617 Visitors; 40 Posts

Thank you Maritimer! Yeah we do not use heparin on the Groshong PICCs, but out ports are PowerPorts...They require heparin its just an issue of how to word how often to use it.

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Boxer Mama works as a RN, BSN.

6,740 Visitors; 291 Posts

Thank you! Yeah we do not use heparin on the Groshong PICCs, but out ports are PowerPorts...They require heparin its just an issue of how to word how often to use it.

We use PowerPorts and only use heparin when deaccessing. We flush with 10 ml saline every 8 hours, 20 ml saline after blood draws.

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IVRUS has 32 years experience and works as a Clinical Infusion Specialist.

9 Likes; 20,032 Visitors; 1,011 Posts

Standard 40, practice criteria I-6 speaks to HIT. [pg S78) In addition, Standard 28- Practice criteria F speaks to flushing and locking with Saline and / or Heparin flush. Since Heparin flush solution is the only FDA approved locking solution to prevent Fibrin buildup, serious considerations need to made about its use, or Saline only use.

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767 Visitors; 38 Posts

Wow, our policy is different. I have worked on my oncology med surg unit for 14 years and getting a port access/flush refresher course next week. Our policy hasnt changed that I know of. We always flush with 10cc saline 5cc low dose heparin (I know they changed the hep concentration as it is different from our picc heparin now--cant recall off hand) every time we give an med through it or labs and before we deaccess it. I will ask about our policy at the class next week.

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7,643 Visitors; 391 Posts

We use PowerPorts and only use heparin when deaccessing. We flush with 10 ml saline every 8 hours, 20 ml saline after blood draws.

Same at our unit

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AgentBeast has 5 years experience as a BSN, RN and works as a Registered Nurse.

21,381 Visitors; 1,969 Posts

Implanted ports get flushed with 5ml of 100units per ml heparin when deaccessed, All others are flushed with saline. Except for dialysis Caths are locked with sodium citrate.

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767 Visitors; 38 Posts

during my port access refresher class I asked about our policy. Our hospital is switching to only power ports so they can be used for CT scans but we are to continue flushing with 10cc saline (20cc if lab draws) and always 5 units of heparin flush every time we use the port (not sure of concentration off hand) even if we are giving morphine q2hr ivp or something that frequent-unless continuous infusion of course. I asked about HIT and the instructor said its too low of a dose to cause problems.

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IVRUS has 32 years experience and works as a Clinical Infusion Specialist.

9 Likes; 20,032 Visitors; 1,011 Posts

during my port access refresher class I asked about our policy. Our hospital is switching to only power ports so they can be used for CT scans but we are to continue flushing with 10cc saline (20cc if lab draws) and always 5 units of heparin flush every time we use the port (not sure of concentration off hand) even if we are giving morphine q2hr ivp or something that frequent-unless continuous infusion of course. I asked about HIT and the instructor said its too low of a dose to cause problems.

HIT is NOT concentration dependent.

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