Staff Nurse Driven Quality Project Supports Elimination of Heparin Flushes in Central Venous Catheters

Purpose:
The Vascular Access team voiced potential safety concerns for patients exposed to unnecessary amounts of IV unfractionated heparin. The purpose of this project was to determine the least amount of heparin needed to maintain central venous catheter patency and reduce the risk of heparin exposure.

Significance:
A literature review revealed that 3%-5% of patients receiving heparin will develop heparin-induced thrombocytopenia (HIT). The effects of HIT can be irreversible and life threatening. A literature review was inconclusive regarding how much heparin, if any, is needed to maintain central line patency.

Strategy and Implementation:
A two month evaluation of central line occlusion rates comparing the use of saline and heparin was implemented throughout the hospital. During the first month, all central lines were flushed with 250 units of heparin every 12 hours as per hospital policy. During the second month, all central lines were flushed with 5cc normal saline every 12 hours. To ensure compliance with the study, nursing staff received email notification explaining the purpose of the study and information was posted at the unit level. Occlusion rates and the use of anti thrombolytic agents were monitored each month during this pilot. The Vascular Access Team served as a resource for nursing staff to review central line flushing techniques, central line equipment and use of saline and heparin as central line flushes. Central line occlusion rates continue to be monitored on a monthly basis throughout the institution.

Evaluation:
Results revealed an occlusion per catheter day rate of 5.73% for central lines flushed with heparin and 3.78% for central lines flushed with saline. The central line policy was revised to reflect saline flushes for all central lines, excluding dialysis catheters and implanted ports.

Implications for Practice:
A decrease in central line occlusion rate using saline flushes has the potential to reduce the rate of HIT in our hospital and improve patient outcomes. Further multi-site research needs to be conducted to determine statistical significance of flushing central lines with saline flushes