From the Guidelines
Yes, it is appropriate to order a protocol central line flush with heparin for a patient's port-a-cath to prevent clogging, but the most recent and highest quality study suggests that saline flushing is as effective as heparin flushing in preventing catheter occlusion. The standard protocol typically involves flushing with 10 mL of normal saline followed by 5 mL of heparin solution (usually 100 units/mL concentration) 1. However, a recent study found that there is weak evidence that heparin flushing reduces occlusion of catheters, but no evidence that it reduces CRBSI rate 1. For implanted ports like port-a-caths, flushing should be done every 4-6 weeks when the port is not in active use. When the port is being actively used, it should be flushed after each use or at least daily. The saline flush first clears the line of any medications or blood, while the heparin acts as an anticoagulant to prevent blood clot formation within the catheter lumen. This maintenance is crucial because if a port-a-cath becomes occluded, it may require thrombolytic therapy or even replacement, which involves additional procedures and risks for the patient. Always follow your institution's specific protocol, as concentrations and volumes may vary slightly between facilities.
Some key points to consider:
- Flushing with saline is as effective as heparin flushing in preventing catheter occlusion 1
- Heparin flushing may not reduce CRBSI rate 1
- Flushing should be done every 4-6 weeks when the port is not in active use, and after each use or at least daily when the port is being actively used
- The minimum flush volume should be twice the catheter volume 1
- It is not advised to use the catheter for blood sampling, and the use of infusion pumps for HPN may reduce the risk of catheter occlusion 1
From the FDA Drug Label
WARNINGS Heparin is not intended for intramuscular use. Fatal Medication Errors Do not use Heparin Sodium Injection as a ‘‘catheter lock flush’’ product.
- The patient has a port-a-cath and wants it flushed with heparin to prevent clogging.
- According to the heparin label, Heparin Sodium Injection should not be used as a ‘‘catheter lock flush’’ product due to the risk of fatal medication errors.
- It is not okay to order a protocol central line flush with heparin for the patient's port-a-cath 2.
From the Research
Central Line Flush with Heparin
- The patient has a port-a-cath and wants it flushed with heparin to prevent clogging.
- According to the studies, there is no conclusive evidence that heparin flushing is more effective than saline flushing in maintaining patency of central venous catheters 3, 4, 5.
- A study found that heparin flushing was associated with reduced CVC occlusion rates, but the evidence was not strong enough to support its use over saline flushing 5.
- Another study suggested that 10 units of heparin may be as effective as 100 units in maintaining patency of peripherally inserted central catheters, but this was a retrospective and uncontrolled study 6.
- A randomized cross-over study found no significant difference in the incidence of blocked catheters or other complications between heparin flushing and saline flushing 7.
Protocol Central Line Flush
- The patient's request to flush the port-a-cath with heparin can be considered, but it is essential to weigh the potential benefits and risks.
- The evidence suggests that saline flushing may be as effective as heparin flushing in maintaining patency, and it may be a more cost-effective and safer option 4, 5, 7.
- It is crucial to follow the institution's protocol and guidelines for central line maintenance and to consult with the healthcare team before making any decisions.