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

@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.

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. 

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.

@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.

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.

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.

 No locks for CVCs.

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

We also remove them asap.

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

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).

 

We don,t lock CVS 

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!