Care and Maintenance to Reduce Vascular Access Complications
Care and Maintenance to Reduce Vascular Access Complications
Care and Maintenance to Reduce Vascular Access Complications
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Nursing Best Practice GuidelineCritical ThinkingRemember <strong>to</strong> heparinize the device not the client. Some clients that require a significantvolume or concentration of Heparin locking solutions may experience complications. Considerwithdrawal of the heparin lock prior <strong>to</strong> flushing <strong>to</strong> reduce the amount of heparin a client receives.While this is practiced in some settings, there is no scientific evidence <strong>to</strong> support this recommendation.The panel offers this as an option that could be considered based on the risks <strong>and</strong> benefits for someclients at high risk of device occlusion.2. Concentration of SolutionThe concentration of the flushing or locking solution relates <strong>to</strong> the use of heparin. The heparin used shouldbe the lowest therapeutic concentration (e.g., 10 IU/mL) <strong>and</strong> have the smallest volume that will maintainpatency relative <strong>to</strong> the internal volume of the device (DH, 2001b; INS, 2000; RCN, 2003).3. Volume of SolutionFlushing: Nurses will use sufficient volumes of flush solutions <strong>to</strong> clean the internal lumen of the device(3-5 mL for PVAD <strong>and</strong> 10-20 mL for CVAD). The volume after blood withdrawal <strong>and</strong> medicationadministration should be at least 20 mL for all VADs. Macklin (1997) concludes that problems may occurwith <strong>to</strong>o little flush solution but not with <strong>to</strong>o much.Locking: The volume should be at least twice the volume capacity of the catheter lumen (usually between3-10 mL for all devices (Macklin, 1997)) plus the priming volume of all add-on devices of the infusion system(e.g., extension tubing) (INS, 2000).4. Frequency of AdministrationGenerally, flushing shall be performed:■ After blood sampling;■ When converting from continuous <strong>to</strong> intermittent therapies;■ Before <strong>and</strong> after medication administration;■ Before <strong>and</strong> after administration of blood components;■ Before <strong>and</strong> after intermittent therapy; <strong>and</strong>■ For maintenance of a dormant device (INS, 2000; RCN, 2003).Frequency of device use often determines the frequency of flushing <strong>and</strong> locking. Devices usedintermittently are flushed before administration <strong>and</strong> are flushed <strong>and</strong> locked at a minimum after everyinfusion or medication administration. The schedule of catheter flushes varies among practice settings <strong>and</strong>among indwelling devices (Ray, 1999). Despite this, VADs should be flushed <strong>and</strong> locked at establishedintervals <strong>to</strong> maintain patency <strong>and</strong> <strong>to</strong> prevent occlusion.Table 2 summarizes the recommended flushing <strong>and</strong> locking interventions related <strong>to</strong> VAD tip position <strong>and</strong>technology.31