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Clearly your pharmacist does not understand the purposes for flushing any VAD. The saline flush must be done manually to assess patency of the catheter - both central and peripheral. The nurse should be assessing for any resistance to a manual flush from a syringe. There is also a requirement for assessing for a blood return and this can not be achieved with a pump. Both INS and ONS include checking for a blood return in their standards. Please see a recent blog post at www.hadawayassciates.com about this issue, Trouble Getting a Blood Return. Finally, the pump can never detect the fluid pathway. All it can detect is a downstream occlusion. Any catheter can erode through the vessel and the pump will continue to pump fluid into the SC tissue or chest or mediastinum, where ever the catheter tip is located. Saline flushes on a pump is definitely not the standard of care and it prohibits nurses from meeting the standard of care. You must educate this pharmacist about all of the reasons for saline flushes and a pump is not an acceptable method for these purposes. Lynn

I had one other thought on your question yesterday. Is the pharmacist talking bout leaving a slow saline infusion connected to the catheter constantly? If so, this would add a burden for many patients. Managing the fluid container, infusion pump and administration set while trying to ambulate, go to the bathroom and get more active while working toward discharge can slow down that progression. The catheter may also be needed for other activities such as blood sampling. You would need to disconnect that infusion from a single lumen hub, draw the sample and reconnect. This adds manipulation to the hub and increases the risk of infection. Good luck with your educational efforts. Lynn

You can reference the INS Standards that discuss flushing of all CVADs, and the INS INFUSION Nursing textbook, as well as the IV Therapeutics textbook by Lynn Phillips. These all discuss the need to flush a centeral catheter as part of the assessment of patency, which cannot be done via a pump. These references also discuss syringe barrel size, which clearly indicates the flush be done manually, before and after each medication.