Chapter 8: IV Therapy
8.8 Flushing and Locking PVAD-Short, Midlines, CVADs (PICCs, Percutaneous Non Hemodialysis Lines)
Critical Thinking Exercises: Questions, Answers, and Sources / References
- Describe your thought process as you determine what flushing protocol is necessary for a valved percutaneous CVAD non hemodialysis CVCs.
Answer: Think about the purpose of flushing IV cannulas: routine flushing is meant to prevent catheter occlusion. IV cannulas can become occluded from blood clots (fibrin) and / or build up of precipitates from meds, IV fluids including PN. In addition, proper flushing and locking might eliminate potential nesting material for microorganisms and as such reduce the risk of catheter related blood stream infections (Ferroni et al., 2014). The nurse needs to know what kind of venous access device the patient has, what solutions are being infused and how often, if the device is peripheral or centrally located, the number of lumens, and if the lumens are open (non-valved) or closed (valved). Generally CVC lumens are flushed before and after all IV meds. CVC lumens that are in use AND those not in use are routinely flushed. It is important to follow agency guidelines.
Think about the structure of the IV cannula: A valved CVAD has an internal mechanism to prevent blood reflux thus the use of an anticoagulant (heparin) is not necessary as part of the locking procedure. A valved CVAD has an internal mechanism to prevent blood reflux thus the use of an anticoagulant (heparin) is not necessary as part of the locking procedure.
Think about what guidelines are available in your agency: Agencies should have flushing protocols available to provide the nurse with guidance in relation to volume and frequency of flushing.
Think about add on IV equipment and what maintenance they need: The nurse must also understand the equipment available to them. Ie. what kind of needleless cap is being used. Neutral displacement and positive pressure valves (caps) can be used. Some syringes are specifically designed and if used correctly (remove the syringe before bottoming out) create the necessary positive pressure to prevent blood reflux into the catheter. This is important if the lumen will not have a continuous infusion running following the flush.
Some general guidelines include:
- Before use, CVADs should be checked for patency using a 10 ml or larger syringe containing saline.
- Patency is checked by aspirating. On a PICC, midline, and percutaneous non hemodialysis CVAD aspirating should reveal blood flashback into the tubing.
- 10 ml syinges of 0.9% NS should be used to flush CVADs to reduce the risk of catheter fracture. Smaller syringes have higher PSI thus risk of catheter damage.
- Always follow the manufacturer’s instructions when using needleless caps, as different techniques are required for different caps.
- The volume of the flush solution will depend on the volume of the catheter and any add on devices.
- Turbulent flush is a rapid st