removing heparin from ports

[Mr. Murse]

I was having this discussion at work the other day and wanted to see what the consensus is around here......

How many of you remove the dwell heparin from a hep locked port before using it?

I'm familiar with all the HIT concerns and what not, but I've heard arguments from both sides. I haven't found a facility specific policy regarding this at my workplace, and I'm not in the habit of removing it.

A new nurse asked my opinion after another nurse had told her to remove it.

[SoldierNurse22, BSN, RN]

At my old facility, we used to draw off the heparin first. It was an oncology unit and the idea was that the patients were already in a fragile state of health, so no one wanted to add a coag issue to the laundry list. However, if you actually watch how much heparin comes off when you draw off the heparin, it's usually less than 1mL, whereas the total volume of the flush can range from 3-5mL. In other words, the majority of your dose is going into the bloodstream; very little actually remains in the lumen of the line. Based on that alone, I never figured it made much of a difference whether or not you drew off or flushed through the heparin lock.

[iluvivt, BSN, RN]

The INS does not recommend removing Heparin from venous access ports. They do however recommend doing so on HD catheters due to the higher concentration used on these devices. check this out:http://www.ins1.org/files/public/09_12_Infusion_Spotlight.pdf

All you need to do is access if needed and verify patency. If you do have a locked port in a hospital, clinic or home care setting that is being used frequently (at least daily) you can lower the Heparin concentration. I lowered ours to 10 units per ml (5 mls) . Upon deaccess we left it at 100 units per ml (5ml). You want to flush with 2x the priming volume of the particular VAD you are going to flush.

[KelRN215, BSN, RN]

I've never removed heparin from a port-a-cath when accessing it- in the hospital or in home care. When I worked in the hospital, we used to remove antibiotic locks (they'll do anything to save a child's central access) but before I left, that policy was changed to just flush them through as well.

[sistrmoon, BSN, RN]

I've worked Onc for 7 years and have never removed the heparin from a port when accessing it.

[calivianya, BSN, RN]

The flushes we use with our PICCs/triple lumens are only 1ml, and it seems like such an inconsequential dose of heparin. I have personally never thought to remove it. I believe we use the 100u/1ml syringes.

Now, if I access a patient's dialysis catheter, I remove it. Those have a substantially higher amount of heparin in them - 5000 units at my facility, I believe. It would take flushing a triple lumen port with heparin in it 50 times to equal flushing a dialysis catheter with heparin in it once.

Is there any research about the 300 units from the 1ml flushes being harmful if the patient's platelet count and coags are normal?

[IVRUS, BSN, RN]

As previous posters have said, including my favorite (ILUVIVT) the concentration used with an implanted port is usually 100unit per ml versus dialysis catheters which are locked with a much higher concentration. Also, remember that HIT is NOT concentration dependant. It can happen to your patient with any amount of heparin or heparin flush solution.