Re: Flushing CVAD lumens

[Tim Spencer]

Hi Joanne,
I will try and answer your questions as you have outlined below;

1. Do you flush all un-used lumens (if not heparin locked) for all patients? Or just some groups of patients? E.g Haematology

Yes, ALL unused lumens should be flushed in every patient – this helps maintain catheter patency, reduces intraluminal biofilm and at a minimum, is performed using devices that promotes a sterile fluid pathway.

2. If you flush – how often – e.g once per shift, once per day?
Once per shift is generally enough – too mancy device accesses with increase the risk of infection (particularly if not performed under strict guidelines).
The choice of normal saline or heparinised saline locking should be based on your institutions preferences/recommendations and the current evidence-based practices.
You can find these in a number of quality guidelines – INS, CDC, HICPAC, NICE and SHEA) – I have attached the ESPEN guideliens as I am currently out of the office on leave and dont have access to my regular guideline files.

3. Does anyone replace CVAD (using a guidewire) in the situation where the CVAD in-situ has (for example) 5 lumens – inserted in ICU – and on transfer to the wards only needs 2 lumens for on-going clinical management. Providing there is no evidence of sepsis, insertion site is OK etc. Or do you leave the 5 lumen CVAD in and flush the lumens or just note they are not in use and not use them form this point on

Guidewire exchange should only be performed when there is NO evidence of local or systemic infection (as I’m sure you are aware).
I would consider replacing the device with the most appropriate device that the patient needs – this should be done be reviewing patients current or intended IV therapies and making a decision based on the 5 rights of Vascular Access;
The RIGHT trained clinician will insert:
The RIGHT vascular device in the:
The RIGHT vessel for the:
The RIGHT patient at the:
The RIGHT time.
This concept will guide clinicians to utilise the best process for determining the patients best vascular access requirements.
Remember, not every patient NEEDS a CVC – a PICC or midline might be more suitable post-ICU discharge (depending on medications being infused).

The CDC guidelines don’t address flushing of lumens, I can only find it addressed in Oncology (referenced to UK Guidelines) and the ANZICS guide (not referenced)

I can send you the current guidelines on this when I return to work if you are interested.

Regards,

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob +61(0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au

—–Original Message—–
Hi All

I am reviewing our current CVAD policy – and I need to include an item around flushing un-used lumens

1. Do you flush all un-used lumens (if not heparin locked) for all patients? Or just some groups of patients? E.g Haematology

2. If you flush – how often – e.g once per shift, once per day?

3. Does anyone replace CVAD (using a guidewire) in the situation where the CVAD in-situ has (for example) 5 lumens – inserted in ICU – and on transfer to the wards only needs 2 lumens for on-going clinical management. Providing there is no evidence of sepsis, insertion site is OK etc. Or do you leave the 5 lumen CVAD in and flush the lumens or just note they are not in use and not use them form this point on

The CDC guidelines don’t address flushing of lumens, I can only find it addressed in Oncology (referenced to UK Guidelines) and the ANZICS guide (not referenced)

Thanks for the help

Regards

Jo

Joanne Cocks | Infection Control Coordinator
St Vincent’s Melbourne | PO Box 2900 | 41 Victoria Parade, Fitzroy VIC 3065
t: +61 3 9288 4069 | f: +61 3 9288 4068 http://www.svhm.org.au
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