Do you flush and lock….

…those vascular access devices?  Of course… all nurses who care for vascular access devices (VAD) should, right?? …. but do they ” flush and lock” or ” flush” only thinking that flushing is enough to keep the VAD patent?

The 2011 Infusion Nursing  standards of practice makes this distinction….

Flushing” – the act of moving fluids, medications, blood, blood products, and nutrients out of a vascular access device into the blood stream, ensuring delivery of those components and verifying device patency.

“Locking” – the instillation of a solution into a vascular access device to maintain device patency.

Some key points to remember:

  • As part of the assessment of the VAD function, flush prior to each infusion and after to clear the medication/fluid from the catheter lumen.
  • Use preservative free 0.9% Sodium Chloride for flushing.
  • When assessing for catheter function prior to use, aspirate for blood return.
  • Lock the VAD after the completion of the final flush to decrease the risk of occlusion.
  • Lock short PIVs with preservative free 0.9% Sodium Chloride in adults and children.
  • For CVAD, INS recommends the use of heparin lock solution 10units/ml after each intermittent use. Ports – use heparin 100u/ml. Hemodialysis/Aphresis – use 1000units/ml.
  • Volume depends on catheter type/size, age of patient, and type of infusion given. Minimum volume is twice the internal volume of catheter.
  • The organization must have policies and procedures on flushing and locking VAD.

Reference: 2011 Infusion Nursing Standards of Practice. Click here to order a copy.

4 thoughts on “Do you flush and lock….

  1. We did away with using Heparin to lock anything but dialysis caths due to HIT. I’m surprised to see it as a recommendation.

    • Many studies report same outcomes in central lines locked with heparin or preservative free saline. Others have reported greater complications with saline locking. Because of the risk and cost associated with central line insertion, they recommend locking with heparin 10u/mL after each intermittent use.
      Thanks for your comment.

      Cora (@infusionnurse)

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