Pushing Heparin through a Peripheral IV

[nrsing2011]

Hi,

I am a nursing student and one of my patients today had a peripheral IV in the wrist that I couldn't get to draw blood, but it flushed. I called over my preceptor, and she decided to flush a 10mL heparin flush through it. The pt did have very poor veins and it would have been next to IMPOSSIBLE to start a new IV somewhere else, as it took 6 tries to get that one when it was put in the previous day. I am familiar with flushing ports with heparin as I work on a chemo unit, but have never seen anyone use heparin as a flush into the periphery. My question is, is that okay?? Didn't the patient just get 500 units of heparin??

And yes, it worked after she flushed it with it.

Thanks in advance for your help!:)

[2ndyearstudent, CNA]

I am familiar with flushing ports with heparin as I work on a chemo unit, but have never seen anyone use heparin as a flush into the periphery. My question is, is that okay?? Didn't the patient just get 500 units of heparin??

And yes, it worked after she flushed it with it.

Thanks in advance for your help!:)

This would have made me raise my eyebrows too. What is the facility policy? Since there were heparin flushes available they should have had protocols in place that covered your instructor's actions.

I think current practice is moving away using heparin flushes because they found that they didn't work much better than saline.

As a student, I wouldn't consider putting heparin anything into any IV. (Last time I gave heparin, the Pyxis made me pinky swear I had no intention of putting it into anyone's IV line). SubQ heparin only for this particular noob.

[nrsing2011]

Thanks for your answer! Thats exactly what I was thinking (as I've seen that same Pyxis request when I have given it).

I just felt I should add for whoever else may read this that the heparin flushes were available because it was a chemotherapy unit, so a lot of the patients have ports which occasionally when they become clogged, are injected with heparin to unclog. However, the port actually holds 5-6 mL, and therefore whatever you are injecting into it, actually sits in the port and does not go into the patient, as you draw it back out of them 24-48 hours later.

[IVRUS, BSN, RN]

First of all, remember that it is against Infusion Therapy standards (INS) to draw from a short term, less than 3 inch IV catheter, unless you are drawing blood from it right when it was placed. Even midline IV catheters can be unreliable for blood drawing as they usually are 3french catheters. If you need to draw a blood specimen and all the patient has is a short term peripheral catheter, it's important to get that specimen peripherally. Use a 23-25 gauge butterfly if you have to. Also... Many IV catheters over 3 inches in length are open ended, or non-valved catheters and they require HEPARIN FLUSH solution in them as a final flush to maintain patency of the line. Whether you use a 10 unit per ml heparin flush solution, or a 100 unit per ml solution. Use it to keep your catheter patent. These flush solutions ARE different then the 5,000 units per ml that you inject SQ.

[2ndyearstudent, CNA]

These flush solutions ARE different then the 5,000 units per ml that you inject SQ.

Yeah. I was being a little facetious about the SQ heparin.