Heparin Lock

[Francesco Cardona]

I am curious. Do you lock your central venous catheters which are not in use? How often do you change the lock?

[Stefan Johansson]

@fcardona my answer is simple - we don't use locks for central ven catheters, we keep infusions going (at least 1 ml/h) until we take them out.

[gayle omansky]

We also run our central venous caths at min of 1ml/hr. We recently locked one side of a double lumen venous cath (as a physician preference), & found that it clotted even with regular flushes. 

[livesynapse]

I agree. No locks for CVCs. 

However, we have been able to keep them from clotting with saline at 0.8cc/h in very tiny babies in whom we really need to watch fluid intakes.

[Stefan Johansson]

@gayle omansky @livesynapse Do you add heparin to your infusion solution (used at 0.8 /1.0 ml/h)?

The "Stockholm tradition" has been: hospitals on the northern side adds heparin, whereas those on the south side don't use heparin. I changed employer in 2014 and is now with a non-heparin NICU Since I came from a pro-heparin hospital I was a bit skeptical about not adding heparin to our low-flow saline in central catheters/lines. But, it seems to work equally well.

[Francesco Cardona]

If we continue with low rate infusion, we add heparin to the infusion solution 2 IE/kg/h. I am not really sure that makes sense.

[RMM]

Our unit does not lock our CVL or PICC's. We run heparinized saline at 1.0ml/hr to keep them patent or we remove them as soon as they are longer needed.

[amirmasoud2012]

 No locks for CVCs.

[livesynapse]

No heparin. Just saline and, as long as the infusion keeps going, they don't clog.

We also remove them asap.

[cmcdermott]

We also do not use heparin or locks but run an infusion at 1ml/hr.  If not required we remove the line ASAP

[Francesco Cardona]

Here is some literature on the subject:

http://www.ncbi.nlm.nih.gov/pubmed/27222450?dopt=Abstract

Quote

Int J Nurs Stud. 2016 Jul;59:51-9. Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children: A systematic review. Bradford NK(1), Edwards RM(2), Chan RJ(3).

 

[Aymen Eshene]

We don,t lock CVS 

[gayle omansky]

Hi Stephan,

We still add Heparin to all our central line infusions at 0.5u/ml. This is a very interesting discussion & we may need to reconsider our practice. Thanks!