I have generated much discussion lately by stating that ALL lumens of central lines need to be checked for patency (meaning aspirating and flushing) at least every 12 hours, and also before med administration. RNs are telling me that if there is an infusion infusing into the lumen, they do not routinely aspirate. They are especially concerned when the infusion is a vasopressor, chemo, etc. I have 2 questions: 1) how do you aspirate blood in a lumen with a vasopressor infusing, without flushing a bolus of the med to the patient? and 2) is there a way to check for patency without opening the line by removing the injection cap?
Thanks so much.
I would start by saying there is no evidence to support checking a lumen when there is continuous fluids infusing, especially with drugs where the flush would inject a bolus of a critical drug. I would never open the system to aspirate for a blood return on a routine or scheduled basis. You would have to rely on the pump beeping an occlusion alarm, and then investigate that situation which could easily mean a manual flush to assess for resistance and aspirate for a blood return. For lumens that are being used only for intermittent medictions, I would only flush and lock after the med has infused and would not do additional flushes every shift - no evidence that this is necessary. For a lumen that is not being used for anything, I would flush and lock at least once every 24 hours; some do it every 12 hours, but there is no evidence to support the frequency of this. It has thus far been driven by the patient location - hospitals do it q 12, ambulatory infusion does it when the patient comes in for an infusion and home care does it usually once per day. Removal of the needleless connector will not be sufficient to allow for backflow of blood far enough to make the necessary assessment, plus part of the assessment is manual flushing to determine if you are meeting any resistance. The goal is minimum manipulation of the entire system to reduce the chance of introducing organisms. This must be balanced against the patency assessment. I would focus on aspiration from lumens being used for intermittent infusion or not being used for anything, along with the pump alarms when a continuous infusion is going through one or two lumens. You would also need to ask the patient about any strange, different, or unusual feelings in his chest as this is also a symptom of the VAD impinging on the vein wall or complete erosion through the vein wall. This is not a perfect science and there are many aspects that require critical thinking on the part of the nurse. Most of this would fit better in the practice guidelines section of your internal policy, procedure, and practice guidelines documents. You don't want a policy to include these details because there is so much that depends upon nursing assessment and judgment. The practice guidelines section should be written based on the nursing process. 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
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