I have wondered abou the saline only in the
homecare setting for many years. I know hospitals have been doing it for
years, but I can't tell you how many times (most recently last week) I have
arrived to open a homecare patient, only to find lines clotted off. In my
most recent example, it was a powerpicc, 5FDL. Both lumens firmly clotted,
and supposedly this hospital still uses Heparin. I don't know if it is a
matter of the patient being more active, up and around, versus more recumbent in
the hospital, a matter of flushing incorrectly and/or choice of cap(s), or the
time elapsed between discharge and initial home visit. In this case
it was a q24 hr dose of Vanco. Most manufacturers recommend flushing PICCs
q12h. What have others experienced with this? How often do you have
homecare patients flush their PICCs if it is a once daily dose. I always
recommend that the patient flushes BID, because when they haven't I see alot of
sluggish or clotted lines. There are so many factors in home care that
aren't totally controllable. Anyone out there in homecare using
saline only? If so, and the line is not a Groshong PICC, what do you
recommend for flushing when the dose is q24hrs or greater.
Halle Utter, RN, BSN
Intravenous Care, INC
Subject: RE: Saline only flushes for central
catheters
>
> Cheryl Fry CRNI
> University Health Care
> Columbia ,MO
>
> ________________________________
>
> From: [EMAIL PROTECTED] on behalf of Nadine Nakazawa
> Sent: Sat 9/30/2006 8:38 PM
> To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
> Cc: [EMAIL PROTECTED]
> Subject: RE: Saline only flushes for central catheters
>
>
>
>
> We've been trying to do NS flush/locks on all CVCs & PICCs using the MaxPlus
> since May '06. We've had mixed results, although recently I've been hearing
> about fewer complaints. We may move back to heparin for the outpatient
> population since declotting in the home setting is a lot more problematic.
> We moved to 20 mls NS flushes after lab draws.
>
> A struggle to get "consistency of care across the continuum of care". We
> dont' have much control over how and when nurses flush, disconnect the flush
> syringe and THEN clamp the PowerpICCs. They've been inserviced as to this
> technique with posters everywhere, but I think inconsistent practice is
> still causing clotting.
>
> Nadine Nakazawa
>
>
>
>
>>From: "Nauman, Tanya" <[EMAIL PROTECTED]>
>>To: [EMAIL PROTECTED]
>>CC: "Perry, Stephen" <[EMAIL PROTECTED]>
>>Subject: Saline only flushes for central catheters
>>Date: Fri, 29 Sep 2006 12:51:33 -0700
>>
>>We are trialing PowerPICCs right now and several physicians have
>>approached me with their concern over the heparin flush required
>>by our flush policy for open-ended central catheters[10ml NaCl
>>and 2ml Heparin(100 units/ml) Q 8hrs when not in use and after
>>blood draws]. They would like us to change to Saline only flushes.
>> Have any of your hospitals or services gone to saline only flushing?
>>Do you know of any articles supporting this practice. I found one on
>>PubMed from Transfus. Sci June 1997...but that's it.
>> I reviewed the postings in the archives--just would like to get an
>>idea of how many hospitals are actually heparin-free as far as
>>Central line flushing.
>> We are using the MaxPlus cap. I've heard of a "neutral" pressure
>>cap, anyone using those?
>>Thanks so much
>>Tanya
>>I.V. Support
>>SHMC
>>Eugene, OR
>>
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