A recent heparin shortage allowed examination of heparin effectiveness in reducing C.V. thrombosis. Many studies have been performed during periods when heparin flushes (1 0 units/ml) were used and when saline flushes were used instead because of a nationwide heparin shortage. The studies have shown no significant evidence that using heparin over saline in central lines is more effective. .Heparin Flushes Maintaining Central Line Potency Maintaining the function of central venous catheters is an important nursing responsibility, which should be carried out following the best available scientific evidence.
These central lines include peripherally inserted central theaters (Epics), tunneled catheters, and implanted ports. Once placed, the central lines may be left in place for days and if they become occluded by clotted blood or some other mechanical obstruction they cannot be cleared by flushing agents. While a person is hospitalized, the nurse needs to check the IV site to make sure the catheter remains in the vein and is delivering a continuous solution. The nurse also needs to flush the catheter routinely to prevent it from clotting.
Heparin sodium is used as an anticoagulant in intravenous catheters in order to prevent clotting and minimize the incidence f phlebitis. Heparin infusion prolongs the duration of peripherally inserted central venous catheter usability, which permits a higher percentage of therapy completion without increasing adverse effects (Jennet Robertson 1994) and other studies also found heparin’s saline solution as a superior flushing agent to normal saline for IV lines in randomized control trials.
However, although health caregivers believe that small doses of heparin used in flushing of peripheral intravenous lines is harmless, heparin could cause many side effects like hemorrhage, allergic reactions, thermodynamic, infection, and pain at the injection site. Heparin could also have interactions with many other frequently used medications, like ecstatically acid. Heparin is thought to prevent clots developing in the catheter which would decrease or prevent flow through it but might create a potential locus for infection.
It can also interfere with promoting time and other lab results, creating an increased amount time spent my medical staff interpreting those results. Some research suggested using a normal saline flush was sufficient (American Association of Critical Care Nurses, 1993). If the studies show that alien is as effective as heparin when flushing central lines, then the use of saline would avoid patient exposure to heparin-associated risks such as hypersensitivity reactions, local tissue damage, bleeding, and heparin induced thermodynamic (HIT).
Saline will also increase the accuracy of the patients coagulation profile, enhancing patient management. And saline is more cost effective for institutions. But there are some studies that have shown an increase in infections when using saline over heparin. A study was done to establish guidelines on flushing central line catheters and is summarized in Table 6 (Mitchell M. D. Anderson B. J. Williams K. And miscued C. A. Peg. 2012). The guidelines are important to know because each institution has different protocols and policies that can affect the results.
For example, how often an institute flushes central lines could lead to more occlusions or less occlusions regardless of what is being used to flush. Then primary studies were done to compare institutions and their findings or results when flushing with heparin versus saline. Their results are found in tables 7 and 8 (Mitchell M. D. Anderson B. J. Williams K. And Miscued C. A. Peg. 2013 – 2016). In studies of peripheral and arterial catheters, rates of thrombus formation were equivalent, whether saline or a heparin solution was used for flushing.
Randomized trials found that flushing with heparin had no significant effect on catheter potency rates compared with flushing using saline (Gogh). The studies that have been done have not shown a significant difference in the use of heparin versus saline but that could be due to the way the studies were done or by who was participating in them. Some studies were done only on certain types of catheters. Others had more females to males, older to monger, or had patients that needed more frequent flushing than others. Also, the amount of flushing solution according to institution policies and how often to flush.
Most facilities have updated their central line care policies according to their best medical recommendations. Last year Yale New Haven Hospital sent out an urgent practice alert to medical staff stating changes in the central venous catheter device (C.V.) flushing guidelines. They are following recommendations that they are to follow the manufacturer of the catheter’s guidelines whether to flush with heparin or saline. And they listed each type of device and the preferred method of flushing according to manufacturers (Yale New Haven Guidelines attached).
Most common practice we have used in clinical is flushing with heparin 5 units/ml with each use and once every 24 hours. The evidence base on heparin flushing is small. The studies have been inconclusive as to which flushing agent should be preferred. Without this evidence, we do not know how well heparin flushes prevent occlusions or reduce the risk for catheter-related blood stream infections. Further research is needed to determine the effectiveness of saline ND heparin flushes in maintaining central lines for better clinical practice.