Flushing UAC lines

[scrabblern, RN]

Ok, so we were going through PCEP skills tonight and were talking about setting up and managing UACs among other things. I've been in the NICU (off orientation) for about 6 months and before then I spent 1.5 years in CICU. So I'm still adjusting.

We have been taught to flush UAC and UVCs with pulsating action, meaning pressing on the plunger with short bursts and high intensity. So say you have a 1kg baby and you're flushing the UAC with 1ml of NS. You'll pulsate the plunger about probably 5-6 times, maybe even less, so basically you're plunging in 0.2ml per burst.

Here's my concern. Let's say we have a 100kg (220lb) adult. Now, that's a big person. Adult lines are flushed with 10ml of NS. If we're to convert to "baby size" - that would be equivalent to flushing 1kg baby's line with 0.1ml of NS.

But we're flushing 1kg's baby with 1ml, so basically that's like flushing 100kg person with 100ml! That would NEVER happen in the adult world. That is way to high volume for a flush. 250ml is considered a bolus in some adults.

Pulsating 0.2ml for a 1kg baby (which is equivalent to 20ml in adult) worries me. I feel that may be hard on their little hearts. It seems to me that it would be more sensible to just flush UAC slowly at a constant rate.

What are your opinions on this? What do you do in your units? Can you please give me rationale? The rationales that I got was that pulsating action slows the flushing down and is like imitating neonate's HR, which is nonsense to me b/c one would never be able to synchronize the flush burst with the heart. If anything, it seems to me that one would be overloading the heart with such flushing method.

Anyway, please explain this to me!!!

Thank you!

[BittyBabyRN]

I have heard that some nurses on my unit "like" to pulse the flush.... but I do not believe there is evidence behind this. I think it is more personal preference, and their personal thinking that it mimics the HR. I agree with you that this seems like nonsense.

I share your concern with this subject, however, you must consider too the length of the tubing that you are flushing. If you are flushing a line, chances are 0.1 ml, or even 0.2 might not eject all of the medication/fluid out of the line. Although a ton of fluid is not necessarily the most optimum situation, it is the lesser of the two evils, the other being the fluid/medication is not adequately delivered.

[dawngloves, BSN, RN]

I agree with BB. There is no evidence about flushing with a "pulse" rather than straight.

Also, we do not use our art line for anything other than monitoring MAPs and drawing labs, so when we flush, we flush only until all the blood that is in the tubing is back in the baby. Therefore the amount of fluid flushed in is minimal.

Our art lines have a KVO running to maintain patency.

[SteveNNP, MSN, NP]

Anecdotally, when I flush using a pulsatile action, I notice that I can clear the line of blood more quickly with less flush.

[iluvivt, BSN, RN]

The reason for a pulsatile flush or sometimes called a start stop flush or technique (and this goes for adults peds and neonates) is to properly clean the line as well as to prevent reflux of blood into the distal tip. The use ot positive displacement valves (sometimes called positive pressure valves..although this name is not technically accurate) will also prevent this reflux. Now here is a big reason to do it this way...not only can it prevent thrombotic occlusion...it can potentially decrese your patients risk for infection. Blood sitting in any CVC (clotted or not) does increase the pts risk for infection. So Infusion Nurses Society Standards or Practice reccommend this type of flush on all types of CVCS in all patient populations. This type of flush is also important with implanted ports d/t the desing of the portal chamber,where sludge can build up if not flushed in this manner.

[iluvivt, BSN, RN]

The reason for a pulsatile flush or sometimes called a start stop flush or technique (and this goes for adults peds and neonates) is to properly clean the line as well as to prevent reflux of blood into the distal tip. The use ot positive displacement valves (sometimes called positive pressure valves..although this name is not technically accurate) will also prevent this reflux. Now here is a big reason to do it this way...not only can it prevent thrombotic occlusion...it can potentially decrease your patients risk for infection. Blood sitting in any CVC (clotted or not) does increase the pts risk for infection. So Infusion Nurses Society Standards or Practice recommend this type of flush on all types of CVCS in all patient populations. This type of flush is also important with implanted ports d/t the design of the portal chamber,where sludge can build up if not flushed in this manner. PS do not worry about the volume...you need this much to clear the line (should be preservative free by the way)...its better to keep your line patent and keep the infection risk as low as possible.