Our NICU has reduced the heparin concentration in their central line flushes from 10 units/ml to 1unit/ml with no adverse outcomes, i.e. no increase in CLABSI, no increase in occlusions. They flush every 6 hours. I am aware of the INS guidelines which state using hepranized saline at 10units/ml. Our current flushing frequency on our other pediatric patients is every 12 hours with 10 units/ml heparin flush solution. My question is; would it be reasonable to reduce the heparin concentration in flushes for all of our pediatric patients (except for those with ports and those on hemodialysis)? If we reduced the heparin concentration in our flush solution should we also increase the frequency of our flushing regimen to every 8 hours or 6 hours as the NICU is doing? I have been unable to find little in the literature with regards to pediatrics and heparin concentration so the only evidence to draw upon is our own NICU experience. We average just under 800 line days /month in our 60 bed NICU. Unfortunately I cannot tell you right now how many of those are heplocked vs continuous. Your thoughts and expertise on this would be greatly appreciated.
Yolanda Ballam BS,CIC
Infection Prevention and Control
You are correct about the lack of studies on this and many other questions about heparin. I worked on the Flushing and Locking standard and gave a presentation on this recently at the AVA conference. Prior to the 2011 INS SOP release, INS had convene a task force on this issue which produced a set of guidelines on flushing with one card dedicated to peds and neonates. A subgroup of peds and neonatal nurses worked on this section. Due to the lack of evidence, this task force drew from hospital polcies and procedures. This group did not have any recommendations less than 10 units per mL for any tpe of catheter or any type of infusion. Since there was no other evidence available on this age group, the SOP committee did not make any differences by ages in that standard. This group recommended flushing frequency in neonates to be every 6 hours, but for peds this could be every 12 or 24 hours, depending on the type of catheter. So there really are no evidence based answers to your questions. Unfortunately, it appears that you will need to try this regimen, track outcomes, and make your decisions based on that data. If you do this, I really hope you will publish it. There are so many issues involved with flushing and locking including but not limited to the type of needleless connector in use, the techniques being used to flush the syringe, the syringe design itself, the density of the locking solution, the design of the catheter's tip with or without side holes, patient activity and muscular compression on the catheter, and probably more than I can think of now. 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