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Heparin flushes

  • 1.  Heparin flushes

    Posted 12 days ago
    How many of your out patient Chemotherapy centers are still using heparin flushes. I was recently at Vanderbilt and they no longer are using

    Sent from my iPhone


  • 2.  RE: Heparin flushes

    Posted 11 days ago
    We are in our infusion centers.  I know that research has shown that the pulsating method of flushing with saline alone may be enough, but we haven't adopted to that yet

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    Ella-Mae Shupe MSN RN OCN
    Clinical Specialist
    Advent Health
    Orlando FL
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  • 3.  RE: Heparin flushes

    Posted 10 days ago
    I also find that using saline flushes alone when flushing the port feels hard to flush..blood flow slower to start sometimes.

    Aziza Pennington RN MSN FNP





  • 4.  RE: Heparin flushes

    Posted 10 days ago
    The use of push -pause is controversial. Dolan & Costertonapril 2002, Clin Microbiol Rev 167-193 says turbulance enhances adhesion biofilm to wall, so maybe slow steady stream NS is better.

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    Cynthia Chernecky PhD, RN, AOCN, FAAN
    Professor
    Augusta University
    Augusta, GA
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  • 5.  RE: Heparin flushes

    Posted 10 days ago

    Cynthia-

    Could you provide the link to that article regarding the biofilm? I could not find anything underneath the information, and the research I did find suggests pulsatile flow is superior to steady stream flushing. Thanks!



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    Jessica Smith, BSN, RN, CCRN-Alumnus
    Registered Nurse-Outpatient Infusion
    Vanderbilt Ingram Cancer Center
    Nashville, TN
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  • 6.  RE: Heparin flushes

    Posted 10 days ago
    https://pubmed.ncbi.nlm.nih.gov/11932229/

    Sent from my iPhone
    Cynthia Chernecky PhD, RN, AOCN, FAAN
    Professor, Augusta University





  • 7.  RE: Heparin flushes

    Posted 9 days ago
    While there is some truth to this Cynthia, keep in mind this article you're referencing is almost twenty years old. Newer evidence supports the pulsatile, push-pause technique as the best way to flush CVADs for routine maintenance and preventing the catheter from clotting off.
    Also, with the combination of pulsatile technique and the use of one one-way needleless connectors at the catheter hub, heparin flushes are not needed (to prevent clotting). It is all about the technique- pulsatile flush, don't bottom out your flush syringe (leave about 0.5ml), clamp your tubing as you're getting close to the remaining 0.5ml, then detach your syringe *after clamping the tubing*. Combination of these techniques (leaving 0.5ml + clamping before) ensure that the pressure you generated in the walls of the lumen during the pulsatile flushing remains 'locked' in place, and you don't inadvertently suck it back out when detaching the syringe from the catheter.
    The INS also supports this practice/technique.

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    Florence Okafor MPH, MSN, RN, NPD-BC, CPHON
    Professional Development Specialist:
    Adult Oncology; Ambulatory Infusion Center;
    Adolescent & Young Adult Oncology; &
    GYN-Oncology.
    Baylor All Saints Medical Center
    Fort Worth TX
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  • 8.  RE: Heparin flushes

    Posted 9 days ago
    There is no comparative research to show which practice works best To prevent infection and biofilm formation, especially longterm (this is a need). Also, the sequence of how you disconnect depends on type of connector you are using (ie: positive versus negative). I hope we have more research on vascular access as we use it every day.

    Sent from my iPhone
    Cynthia Chernecky PhD, RN, AOCN, FAAN
    Professor, Augusta University
    Email: cchernecky@augusta.edu




  • 9.  RE: Heparin flushes

    Posted 11 days ago
    Correct-we are trialing NS only flushing with the push-pause pulsatile flush technique (at least 10cc) when de-accessing our ports. So far our results mirror other facilities in that we have not had an increase in Alteplase use.

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    Jessica Smith, BSN, RN, CCRN-Alumnus
    Registered Nurse-Outpatient Infusion
    Vanderbilt Ingram Cancer Center
    Nashville, TN
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  • 10.  RE: Heparin flushes

    Posted 10 days ago
    This is interesting. Does anyone have any links to the evidence? At least the title of the article of research?

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    Bryan Larson RN, BSN
    Providence Medford Cancer Institute
    Outpatient Oncology Infusion
    Medford, OR
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  • 11.  RE: Heparin flushes

    Posted 10 days ago

    Bryan-

    Here is one such article I found using Google Scholar. I imagine there are more! 

    Comparison of the effects of heparin and 0.9% sodium chloride solutions in maintenance of patency of central venous catheters

    Mohammad Ali Heidari Gorji, Fatemeh Rezaei, Hedayat Jafari, Jamshid Yazdani Cherati
    Anesthesiology and pain medicine 5 (2), 2015


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    Jessica Smith, BSN, RN, CCRN-Alumnus
    Registered Nurse-Outpatient Infusion
    Vanderbilt Ingram Cancer Center
    Nashville, TN
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  • 12.  RE: Heparin flushes

    Posted 7 days ago
    https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008462.pub3/abstract

    https://rdcu.be/b5iG2

    The Cochrane Library has this review on Heparin versus NS to lock CVCs that was first published in 2014 and updated in 2018.

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    John Hillson RN
    Hillsborough NC
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