2. 10 ml with rapid push/pause after brisk blood return and not bottoming out the syringe Q 12 hr for locked lines inpatient. Q day for locked outpatient.
3. We have noticed if the person is vomiting often, the lumens will clot off. We heparinize those. We have changed types of caps, so I don't know if that would be true now. I use a non valved Power PICC without any increased issues except in the case mentioned.
Flushing and locking all VADs should be in compliance with the INS Standards of Practice, which now states that heparin 10 units per mL is recommended for locking all CVADs. Saline is recommended for locking peripheral catheters. There have been some new studies showing that saline and heparin have essentially equivalent outcomes for CVADs. Personally, I still have a difficult time moving away from heparin and using only saline for locking a CVAD. The most important thing to remember, in my opinion, is that you can not separate flushing and locking technique from the type of needleless connector being used. The flushing-clamping-disconnection sequence is critical. Search this site or go to my company website - www.hadawayassociates.com and look for several published articles about this one the Resources page. Lynn
There has been a lot of discussion this past week regarding an apheresis catheter in a pediatric patient. Our policy is to heparin lock with 10U/ml with a volume of 2 ml q 24 hrs when not in use. Does anyone know of an evidence to support either flushing or aspirating the heparin before use?
This would be a total of 20 units of heparin injected every 24 hours. Have you checked the internal volume of the apheresis catheter to make sure that 2 mL is adequate to fill the catheter's internal volume? Also, what age is the patient? A 2 month old would be quite different from a 6 year old or a 15 year old. Aspriation of any locking solution is usually limited to extremely hish doses used in dialysis catheters. Usually this is 1000 to 5000 units per mL. For your dose of only 20 units, I think injection is acceptable. This is a very small dose and heparin is metabolized within a few hours. Lynn
1. Yes -
2. 10 ml with rapid push/pause after brisk blood return and not bottoming out the syringe Q 12 hr for locked lines inpatient. Q day for locked outpatient.
3. We have noticed if the person is vomiting often, the lumens will clot off. We heparinize those. We have changed types of caps, so I don't know if that would be true now. I use a non valved Power PICC without any increased issues except in the case mentioned.
Flushing and locking all VADs should be in compliance with the INS Standards of Practice, which now states that heparin 10 units per mL is recommended for locking all CVADs. Saline is recommended for locking peripheral catheters. There have been some new studies showing that saline and heparin have essentially equivalent outcomes for CVADs. Personally, I still have a difficult time moving away from heparin and using only saline for locking a CVAD. The most important thing to remember, in my opinion, is that you can not separate flushing and locking technique from the type of needleless connector being used. The flushing-clamping-disconnection sequence is critical. Search this site or go to my company website - www.hadawayassociates.com and look for several published articles about this one the Resources page. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
There has been a lot of discussion this past week regarding an apheresis catheter in a pediatric patient. Our policy is to heparin lock with 10U/ml with a volume of 2 ml q 24 hrs when not in use. Does anyone know of an evidence to support either flushing or aspirating the heparin before use?
This would be a total of 20 units of heparin injected every 24 hours. Have you checked the internal volume of the apheresis catheter to make sure that 2 mL is adequate to fill the catheter's internal volume? Also, what age is the patient? A 2 month old would be quite different from a 6 year old or a 15 year old. Aspriation of any locking solution is usually limited to extremely hish doses used in dialysis catheters. Usually this is 1000 to 5000 units per mL. For your dose of only 20 units, I think injection is acceptable. This is a very small dose and heparin is metabolized within a few hours. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861