NURSING CLINICAL PICO

Normal Saline Flushes and Heparin Flushes

Normal Saline Flushes and Heparin Flushes

Introduction

Catheters are tubes placed under the skin to secure venous access. They may be used in a wide variety of settings and for an assortment of purposes. For example, cancer patients are sometimes fitted with temporary catheters and ports for infusion of chemotherapy so that a nurse does not need to place a line for each treatment, and people in the hospital may be given intravenous lines so that medications can be delivered intravenously and to provide hospital personnel with fast access to the patient's veins.

The longer a catheter is left in place, the higher the probability that it will become blocked by blood clots or other foreign materials. For this reason, the catheter periodically needs to be flushed with a solution which will clear the line. If this is not done, the patient could develop an infection, the catheter could rupture, or the patient's medications might not be delivered.

With a heparin flush, a diluted solution of heparin is injected into the catheter. Heparin is an anticoagulant and it will break up any clots which might be forming in the catheter. Doctors may also use a saline flush, in which the catheter is flushed with sterile saline; sometimes both types of flush are used in catheter management. The heparin flush needs to be performed consistently to keep the catheter clear (Bolgiano et al, 1990).

The heparin solution designed for heparin flushes is not designed for oral or injectable use. It has been formulated specifically for use with catheters, and it is important to use the right dosage, which depends on the type of catheter and the patient. Some companies manufacture heparin flush syringes which are prepackaged with diluted doses and are ready for use. In other cases, a syringe must be prepared for each flush.

One common complication of a heparin flush is bleeding problems. Patients should report symptoms like bleeding gums, dark urine, and unusual bruising to their physicians (Hanson et al, 1976).

The skin is the most common source of organisms causing catheter-related infections. (Widmer, 1993) Coagulase-negative staphylococci are the bacteria most frequently isolated from catheters, but in most cases this colonization does not progress to bacteremia. On the other hand, the isolation of S. aureus from blood cultures is strongly predictive of a catheter-related bacteremia and is associated with a greater incidence of complications such as endocarditis and osteomyelitis.

Review Literature

A central venous catheter (CVC) is a commonly used access device in critically ill patients. Although CVCs enable the administration of life supporting medications and therapies, the presence of these catheters place patients at risk of catheter-related blood stream infections or central line associated bacteraemia (CLAB) which can be fatal. Methods and techniques used during CVC insertion by medical staff and CVC management by nurses are critically important to preventing CLAB. The purpose of this systematic review was to investigate and evaluate research findings regarding the nursing management of CVCs to prevent CLAB in critically ill adults in order ...