Daily flushing is
usually enough, esp in home care. The how is more important than the what. I
found it more common to have clotted lines right after hospital discharge to
home care, the first visit can have all types of problems. They may be lacking
the how and the what on the last dose prior to DC
Nancy Moureau, BSN,
CRNI
PICC Excellence,
Inc.
888-714-1951
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Hallene E Utter
Sent: Sunday, October 01, 2006 8:28 PM
To: Fry, Cheryl; Nadine Nakazawa; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: Re: Saline only flushes for central catheters
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Hallene E Utter
Sent: Sunday, October 01, 2006 8:28 PM
To: Fry, Cheryl; Nadine Nakazawa; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: Re: Saline only flushes for central catheters
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
> We have used normal saline for all lines , peripheral and central for many years. It works just fine as long as the positive pressure technique is used. We do use heparin also for central lines in children and those with Cystic fibrosis because of the high venous pressure when they cough. The real problem is getting the nurses to flush routinely as they should.
>
> 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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>>
>
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>
>
>
>
>
