Maximum Heparin doses with Central Lines

[dmrn722]

I currently work for a facility who has a flushing policy for central lines as follows:

PICC/Hickman flush SASH with 3ml saline and 3 ml of 100u/ml heparin with each use

Implanted Ports- flush SASH with 5- 10ml saline and 5ml of 100u/ml heparin with each use

With patients who have intermittent I.V.s ordered 4 to 6 times a day that is a lot of heparin, especially if the patient has bleeding concerns. What is the experience of everyone else with this? Do you flush the catheters less often with the heparin to decrease the total dosage of heparin used? Any information would be appreciated.

Thanks

[memphispanda, RN]

I was *told* that our policy is the same as what you have mentioned with the exclusion of the PICCS. However, after reading it myself, I discovered it was not.

PICC lines--flush with 10cc NS Qshift and before and after intermittant use for medications. Flush with 20cc NS after using line for blood transfusions or blood draws.

Hickman/IP policy--flush with 20 cc NS after routine use. Heparin is only used Q3 days when hospitalized if the port is being accessed for meds, etc. Heparin is used also when IP access is discontinued for any length of time. IP needs to be heparinized at least monthly when not routinely accessed. I can't remember how often the Hickman needs to be heparinized when not in use (we don't use many of them).

[zambezi, BSN, RN]

On my unit we usually only see PICCS or triple lumens or cordis into the IJ.

For all of these if there is not continuous IV running we flush with 30u heparin Q8 hrs.

[adria37]

The half life of heparin is very short. I know with my indwelling port clients I want them flushed with 5ml's of heparin 100units per ml.

[mariusz]

HELLO EVERYONE!

Lets start using EVIDENCE BASED NURSING PRACTICE. Heparin FLUSH for themost part is LONG GONE- with just a few exceptions- we should not be flusing lines with heparin in the acute care setting, we should NOT be heparanizing pressure line tubing or balloon pump tubing etc. Hasent anyone heard about H.I.T.- heparin induced thrombocytopenia?- 50% of patients who develop it have a thrombotic event- and yes, heparin, lovenox subq, and flushes can contribute to this- all of our 9 hospitals in our network have saline flush policy with exceptions for mediport etc. that will not be in use for 30 days- we flush with heparin on discharge and of course dialysis catheters. In the era of MAGNET staus and evidence based practice we need to really get on the ball with this topic. So worst scenario- line occludes? what can we handle-- occluded catheter or amputated limb from complications of white clott syndrome/H.I.T. The answer is very simple!

[PICC ACE]

First of all,what are the manufacturer's directions? PICC flushing depends on the style of catheter. A valved catheter should not need to be heparinized (i.e Bard's Groshongs or Boston Scientifics PASV's),just use NS. Your port policy sounds OK. You may consider 10 unit/ml Heparin locks for the smaller lumen lines.

[ginger58, ASN, RN]

HELLO EVERYONE!

Lets start using EVIDENCE BASED NURSING PRACTICE. Heparin FLUSH for themost part is LONG GONE- with just a few exceptions- we should not be flusing lines with heparin in the acute care setting, we should NOT be heparanizing pressure line tubing or balloon pump tubing etc. Hasent anyone heard about H.I.T.- heparin induced thrombocytopenia?- 50% of patients who develop it have a thrombotic event- and yes, heparin, lovenox subq, and flushes can contribute to this-clott syndrome. The answer is very simple!

Very well put! Our PICCs are not flushed at all with heparin. As long as they're flushed properly (push-stop-push to create turbulence in the line) and after meds, especially IVPBs, they're fine. The only lines we put heparin in are the PACs upon discharge is they're to remain accessed. I can't speak for other lines since we don't see them.

[PICC ACE]

Speaking of evidence-based...the push/pause technique is ones of those things that sounds good in theory but isn't supported by data. An old wives'/nurses' tale!

[adria37]

Exactly, I work in an outpatient oncology clinic we flush port-a-caths every 4-6 weeks with 10 ml's of NS and 5 ml's of Heparin 100 unit/ml. If you are using the ports several times are they not left accessed?

[acosgro]

I believe Infusion Nursing Standard of practice is not greater than 2000 units of Heparin in a 24 hour period so if you have someone who is receiving multiple intermittent doses you could decrease the volume (Infusion Nursing standard say flush volumes should be twice the volume of the catheter lumen) or decrease to 10 units per ml. HIT can happen with any concentration or volume of heparin, so it is important to know the s/s if you are dealing with any form of heparin.