Our I.C.U is wanting to stop using Heparin flush in central lines  Actually, I think they have stopped long ago but want to make our hospital wide policy on care of central lines match what we are really doing.  They are asking me ( picc line nurse) for info .  I realize the reason for this is to prevent or decrease H.I.T. 

 I have seen many ports that are not flushed with heparin clot off and have some concern about this. (even a port that is actively used while a pt is in the hospital).  I also see that the manufacturer of these devices (ports/piccs/triple lumens)  still recommends the flushing of saline and heparin for these non valved devices.  

How has this been handled in your instituions?  I know some have said they use the positive displacement caps on the lines to decrease the risk of reflux of blood on these open ended ( non valved) lines, and are flushing with saline only.  

Is there any issue with going differently than the  manufacture recommends? 

They are also saying many times if a patient comes in with a line from elsewhere how do they know it is valved or not. Of course I say it needs to be investigated and identified so proper care in deliverd. 

Thank you in advance for any info you provide. 

Gina Ward R.N., CPAN 

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At our acute care facility,

At our acute care facility, we switched our heparin flushing protocols to saline for open ended PICCs, triple lumens, midlines, and the pigtail on hemodialysis catheters.

 In our critical care unit over a 5 month period, our Alteplase usage increased by 360%.  Furthermore, Alteplase use is controlled and used by only our IV therapy team.

Having nurses routinely flush a lumen that is not in continuous use is a challenge and one that I feel has contributed to our occlusions.

With that said, our P&T committee felt more nursing education was needed and we should continue monitoring outcomes, as they did not want to revert back to heparin.

We do use a positive displacement needleless connector.

In the previous 2 messages,

In the previous 2 messages, the authors used the phrase "approved by the FDA". This phrase could be interpreted by some to mean that there is some level of clinical performance that these products must meet  before they are sold in the US. This is not a correct interpretation. In fact, the FDA does not use this word "approved". Most all devices especially the add-on needleless connectors and catheters  being discussed come to the US market under the 510K process, which means that the product must prove substantial equivalence to a similar product already on the market. So there are no clinical performance data or evidence that must be presented to the FDA in the 510K process. All the FDA is doing is clearing these products for the US market or simply giving permission to the manufacturer that it is acceptable to sell their product. Gathering and analyzing data on the clinical performance comes when the product is being used clinically, which is after all the FDA clearance processes. So there is no "approval" of these devices. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

 Gina, Investigate other

 Gina,

Investigate other HCA facilities that have transitioned heparin free. I still work PRN at one of them. My concern is port's frequently get caught in this "blanket" coverage. Port flushing protocols need to be seperated out and then depending if port catheter is valved or not. As always, each patients needs should be individualized and may possibly require heparin. PICC/CVC IFU's that include heparin are how they are approved and recommended by manufacturer. A catheter that is indicated and approved for saline flushing only due to a valve (i.e.SOLO) is ideal to cross the continuum of care no matter what connector each provider utilizes.

Contact me privately if needed

timothy.creamer@crbard.com

Hope this helps.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Florida Division

Timothy L. Creamer RN, CRNI

Clinical Specialist, Bard Access Systems

Florida Division

You will not necessarily be

You will not necessarily be going against manufacturer's instructions for use if you eliminate the use of heparin.  There are many open ended central lines and PICC lines that do not specifically state the need for a heparin flush.  Many now state you may flush with NS, heparin or per your hospital protocol.  Check with your manufacturer. 

There are many valves (end caps) on the market currently that can be used with NS only, both positive displacement and neutral displacement.  These are FDA approved for NS only.  Using a valve/cap with this indication is very effective with all central lines, including open ended CVCs and PICCs.

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Last year, I gave 3 webinars

Last year, I gave 3 webinars for INS that addresses all of these issues. The only way currently that you can eliminate heparin is to use a needleless connector with saline only instructions for use. However studies are showing that saline only produces rates of occlusion in the range of 6% to 11%. Go to the INS website to locate these webinars and the complete list of references for each. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861