My personal feeling is that in-patient hospital nursing staff do not take
ownership of lines like the home care staff do. Too often the inpatient
nursing staff just want to make sure the line is OK until the end of their
shift. The home care staff know that the line is theirs until it is DC'd,
and because of that I think they take better care of the line. Just my
humble opinion......
Alma Kooistra RN, CRNI
----Original Message Follows----
From: "Nancy Moureau" <[EMAIL PROTECTED]>
To: "'Hallene E Utter'" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
Subject: RE: Saline only flushes for central catheters
Date: Mon, 2 Oct 2006 12:37:04 -0400
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
<http://www.piccexcellence.com/> www.piccexcellence.com
<mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED]
-----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
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: <mailto:[EMAIL PROTECTED]>
[EMAIL PROTECTED] on behalf of Nadine Nakazawa
> Sent: Sat 9/30/2006 8:38 PM
> To: <mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED];
<mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED]
> Cc: <mailto:[EMAIL PROTECTED]> [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" < <mailto:[EMAIL PROTECTED]>
[EMAIL PROTECTED]>
>>To: <mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED]
>>CC: "Perry, Stephen" < <mailto:[EMAIL PROTECTED]>
[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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>
>
>
>
>
>
>
