Episode 218: Central Venous Catheters: Heparin Harms and Recommendations for Flushing

"Saline is very benign and doesn't have any risk of harm for the patient. They're small doses, so we're not worried about sodium or anything. The risk of heparin is actually quite extensive," MiKaela Olsen, DNP, APRN-CNS, AOCNS®, FAAN, clinical program director in oncology at Johns Hopkins Hospital and Johns Hopkins Health System in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a conversation about the latest evidence surrounding central venous catheter flushing solutions and techniques. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities. ONS Access Device Standards Oncology Nursing Podcast Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments Episode 162: What Nurses Need to Know About Central Lines and Ports Clinical Journal of Oncology Nursing articles Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Pediatric Patients With Cancer Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Patients Undergoing Blood and Marrow Transplantation Implanted Port Patency: Comparing Heparin and Normal Saline Central Venous Access Devices: An Investigation of Oncology Nurses' Troubleshooting Techniques ONS books Access Device Standards of Practice for Oncology Nursing Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice Journal of Vascular Access article: Flushing of Intravascular Access Devices (IVADS) – Efficacy of Pulsed and Continuous Infusions Medical Devices: Evidence and Research article: Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices ASCO/ONS Chemotherapy Administration Safety Standards ONS/ONCC Chemotherapy Immunotherapy Certificate Course Infusion Nurses Society's Infusion Therapy Standards of Practice To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email [email protected]. Highlights From Today's Conversation "The way that you can eliminate heparin is by really focusing on education and teaching of patients and nurses and other staff that access central lines about how to do that." Timestamp (TS) 06:13 "One of the barriers right now I think is that a lot of the manufacturer guidelines are old, and they still recommend in their catheter guidelines to use heparin because they aren't up to date either." TS 07:50 "The risk of heparin is actually quite extensive. For instance, we know that heparin can cause heparin-induced thrombocytopenia, or HIT. Unfortunately, you don't always know that your patient is experiencing that, but I've had many, many patients over the years where, all of a sudden, their platelet count was low, and no one knew why. . . . We did testing for HIT and found out that it was the heparin flushes that were causing that." TS 09:04 "Normal saline is the most benign solution that can be used in catheters. There are studies showing benefit in some patient populations, and I know that some places have protocols using an antibiotic lock solution or a sodium citrate lock solution, but in general the most common type of flush solution for central lines as heparin begins to move out of favor is normal saline." TS 13:06 "We know that using a push-pause, pulsatile, or, I call it sometimes, turbulent flush, has been shown to promote the clearance of the catheter lumen and prevent occlusion. According to the Infusion Nursing Society guidelines. . . . we are instructed to stop and start every millimeter of flush. . . . That is really important because every time you stop and start, you cause turbulence in that catheter." TS 13:55 "When you study it, you find that patients or nurses are not actually flushing enough. If the patient's at home and you're using saline, then the catheter is usually flushed on a daily basis with pulsation when not in use. If the patient's giving themselves antibiotics or other medications through their catheter, they need to be taught how to do the saline flush after each of the medications." TS 17:47