Re: Eliminating heparin from peripheral flushes

[Janet Pettit]

I think the difficulty with maintaining patency of the 24-gauge catheters is multifactorial.  Factors in neonates include increase in hematocrit (typically 40-60), hypercoagulable state, lack of regular site change...  These factors don't exist in the typical adult who may also have a 24-gauge PIV.  You can review the Cochrane report regarding heparin flushing in neonates:  www.nichd.nih.gov/cochrane/shah5/SHAH.HTM , but the conclusion is stated below. "Implications for practice: The effect of heparin on the duration of peripheral intravenous catheter use varied across the studies. Because of clinical heterogeneity and heterogeneity in treatment effect, recommendations for heparin use in neonates with PIV catheters cannot be made " Janet Pettit NP On Dec 8, 2005, at 4:52 PM, Dianne Sim wrote: We service multiple SNFs who flush their 24Ga cannulas (and others) q24 and have not had a problem with occlusions. I think the answer lies with the positive pressure valves. We use UltraSite. Regards, Dianne Sim IV Assist, Inc -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Rakay Dance Sent: Thursday, December 08, 2005 4:16 PM To: Tim Talbert Cc: [EMAIL PROTECTED] Subject: RE: Eliminating heparin from peripheral flushes 24 gauge catheters need to be flushed much more often to keep patent. In the NICU where I worked we had to change our policy to q2-3 hour flushes when we switched to saline from heparin because of the large number of clotted catheters.  Almost 100% clotted by 8 hours.  We were not using positive pressure valves at that time.  RaKay -----Original Message----- From: Tim Talbert [mailto:[EMAIL PROTECTED]]  Sent: Thursday, December 08, 2005 4:27 PM To: Janice Patten; Rakay Dance Cc: [EMAIL PROTECTED] Subject: RE: Eliminating heparin from peripheral flushes Why would the gauge of the catheter matter? Tim "Rakay Dance" <[EMAIL PROTECTED]> 12/8/05 >>> There is an article in the new INS journal stating that q24 flushing is best for PIV's on ambulatory patients but I wonder what size catheter they were using?  I would love it if it would work and I would try it with a 22 but not a 24.   RaKay -----Original Message----- From: [EMAIL PROTECTED]  [mailto:[EMAIL PROTECTED]] On Behalf Of Janice Patten Sent: Wednesday, December 07, 2005 1:03 PM To: [EMAIL PROTECTED]  Subject: Eliminating heparin from peripheral flushes One of JCAHO's proposed National Patient Safety Goals in 2007 is to eliminate heparin from flushing peripheral lines.  For patients in the home care setting, I'm just curious to see if you think lines will clot off in 24 hours if the line is used only once daily (e.g. for Invanz). Is it reasonable to make an extra nursing visit on unteachable patients to flush BID w/ saline? Jan Patten PharmD Director, Infusion Therapy Pathways Home Care (NorthEast Medical Center) 487 Lake Concord Road Concord, NC  28025 704 784-7116 office 704 786-2674 fax 704 773-0229 cell 704 723-8324 pager [EMAIL PROTECTED]  This electronic message may contain confidential information.  It is intended for the use of the individual(s) named as recipients in the message.  If you have received this message in error, please notify the person listed above immediately by e-mail, and delete the original message and attachments.  Do not disclose its contents or take any action in reliance on the information it contains.  Thank you. Notice from St.Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure.