Heparin Flushes Maintaining Central Line Patency
Gateway Community College
A common problem that complicates use of central venous access devices (CVADs) is occlusion by thrombosis. Heparin has been used in flushing solutions in attempts to prolong the patency of arterial and central venous lines by preventing these occlusions. Its use, however is not without risks such as hypersensitivity reactions and heparin-induced thrombocytopenia. Recent studies suggest that non-heparinized solutions, such as saline, may be as effective in maintaining catheter patency. A recent heparin shortage allowed examination of heparin effectiveness in reducing CVAD thrombosis. Many studies have been performed during periods when heparin flushes (10 units/mL) were used and when saline flushes were used instead because of a nationwide heparin shortage. The studies have shown no significant evidence that using heparin over saline in central lines is more effective. .Heparin Flushes Maintaining Central Line Patency
Maintaining the function of central venous catheters is an important nursing responsibility, which should be carried out following the best available scientific evidence. These central lines include peripherally inserted central catheters (PICCs), tunneled catheters, and implanted ports. Once placed, the central lines may be left in place for days and if they become occluded by clotted blood or some other mechanical obstruction they cannot be cleared by flushing agents. While a person is hospitalized, the nurse needs to check the IV site to make sure the catheter remains in the vein and is delivering a continuous solution. The nurse also needs to flush the catheter routinely to prevent it from clotting. Heparin sodium is used as an anticoagulant in intravenous catheters in order to prevent clotting and minimize the incidence of phlebitis. Heparin infusion prolongs the duration of peripherally inserted central venous catheter usability, which permits a higher percentage of therapy completion without increasing adverse effects (Jeannette Robertson 1994) and other studies also found heparinized saline solution as a superior flushing agent to normal saline for IV lines in randomized control trials. However, although health caregivers believe that small doses of heparin used in flushing of peripheral intravenous lines is harmless, heparin could cause many side effects like hemorrhage, allergic reactions, thrombocytopenia, infection, and pain at the injection site. Heparin could also have interactions with many other frequently used medications, like acetylsalicylic acid. Heparin is thought to prevent clots developing in the catheter which would decrease or prevent flow through it but might create a potential locus for infection. It can also interfere with prothrombin time and other lab results, creating an increased amount time spent my medical staff interpreting those results. Some research suggested using a normal saline flush was sufficient (American Association of Critical Care Nurses, 1993). If the studies show that saline is as effective as heparin when flushing central lines, then the use of saline would avoid patient exposure to heparin-associated risks such as hypersensitivity reactions, local tissue damage, bleeding, and heparin induced thrombocytopenia (HIT). Saline will also increase the accuracy of the patient’s coagulation profile, enhancing patient management. And saline is more cost effective for institutions. But there are some studies that have shown an increase in infections when using saline over heparin. A study was done to establish guidelines on flushing central line catheters and is summarized in Table 6 (Mitchell M.D. Anderson B.J. Williams K. and Umscheid C.A. pg. 2012). The guidelines are important to know because each institution has different protocols and policies that can affect the results. For example, how often an institute flushes central lines could lead to more...
References: American Association of Critical-Care Nurses (1993) Evaluation of the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines. American Journal of Critical Care; 2: 1, 3-15.
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