Hi!
Need thoughts for the following:
For intermittent dosing on ambulatory (home care) infusion pumps: when the bag is changed every 24 hours, and a new bag loaded immediately, must the VAD be flushed with saline 10ml? I have always instructed it is not needed, but there is differing opinions on this one. The new bag may start at the KVO rate or at the dosing rate once turned on.
If a patient will be off the pump longer that a few minutes, we do have them saline flush, and if longer than that then we have them heparinize using 10units/ml, 5ml.
Thanks everyone for your responses.
Laura
Who is doing the flushing - patient or nurse? The only reason to flush is to assess patency and aspirate for a blood return. If the nurse is doing the bag change, then I would say yes it should be assessed for a blood return and resistance to flushing. If the patient is doing it, then I would say no because they would not know how to do the complete assessment. The ambulatory infusion pump will provide a constant flow and prevent occlusion while it is connected. I do agree that if the time off the pump will be extended then it would require flushing and locking. 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
Until the patient is fully independent in pump bag changes then it is the nurse, and once independent then the patient. Once weekly, during labs and sterile dressing changes the nurse is to routinely flush (post dressing change) to check for continued patency.
Thank you as always Lynn. If the issue is checking for patency, and is not a requirement for clearing/cleaning the lumen after hours of drug moving through the lumen, then I feel comfortable with informing staff that routine flushing by patients is not needed. But periodic RN assessment of patency is. Correct?
Laura Lenihan, RN
Clinical Specialty Coordinator
Henry Ford Home Health Care
(313) 874-6572
fax (313) 874-6501
I would like to have some others from home care add to this discussion, but my understanding is that nurses in home care are assessing for patency and this is not generally being taught to patients. Flushing will not "clean" the lumen walls of any biofilm or fibrin because these substances are so firmly attached to those intraluminal walls. If flushing is hard enough to cause any disturbance in biofilm or fibrin could lead to BIS and/or a shower of small clots. Also this type of forceful flushing could cause alteration in catheter tip location. 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
We do NOT want our home patients to be assessing for blood return because we can't guarantee they will adequately flush the line to prevent occlusion. We also do not have them flush between bags. And we are saline only, no heparin. We have been doing it this way for years, with the RN checking it with weekly dressing change/visit and it works fine. Ann williams RN CRNI, Infusion Specialist, Deaconess Home Infusion, Evansville, IN
What kind of a pump are you using? We use several different types of pumps and our flushing protocols for patients depends on the pump being used. For instance if we are using a CADD and the patient is changing the bag daily, even if the dose is intermittent we do not have the pateint disconnect from the pump to flush the line.
Lydia Harris RN BSN CRNI
Clinical Infusion Nursing Manager
Providence Home Services