Title : Analysis of an evidenced based practice change: Normal saline vs. heparin solution flushes for central line maintenance of oncology patients
Context: Guidelines and clinical practice for preventing complications with central venous catheters (CVC) varies greatly across the world. Preventing occlusion dictates most institutions endorse the use of heparin to maintain patency when the CVC is not in use. However, the use of heparin may be unnecessary, provide risk to the patient, and increase health care costs. The American Society of Clinical Oncology Clinical Practice Guideline: Central Venous Catheter Care for the Patient with Cancer recommends routine flushing with saline. There is a need for evidence to validate normal saline may as effective alternative to heparin in line patency.
Objective: To evaluate the outcome of an evidence-based practice change and validate the American Society of Clinical Oncology ( ASCO) recommendation of CVC care using routine flushing with saline.
Design: In December of 2014 WVU Oncology Services initiated an evidence-based practice change and removed heparin solution from central line protocols for flushing of the adult cancer patient. Research using a convenience sample equaling 1922 patients in visits over an 8 month period was retrospectively reviewed after the evidence based practice change for outcomes of heparin vs. saline flushing in line patency.
Setting: An outpatient ambulatory academic comprehensive cancer center with laboratory and infusion services for adult oncology patients.
Results: Implementation of a practice change to include pre-implementation education, mandatory in- services, annual competencies, and informative posters with proper flushing technique to educate staff validating the use of a pushpause technique for saline flushing, which is not inferior to heparin for maintaining central line patency for adult oncology patients.
Conclusions: There is sufficient evidence with pre implementation education and proper flushing technique to advocate saline flushes are effective in maintaining line patency in the adult population without the additional cost or clinical syndromes associated with heparin based flushing of CVC.
Audience Take Away:
• Normal Saline flushing with an educationally implemented push pause technique to create turbulence in the lumen to optimize rinsing effect on the catheter allows nurses to make a practice change with confidence in the knowledge that 0.9% normal saline flushes are not inferior to heparin flushes for adult oncology patients with CVC lines at WVU Medicine and MBRCC.
• An initial savings was seen with removal of the heparin solution for CVC flushing. In the 4 month period prior to the practice change the cost of the pre-filled heparin syringes used was 3,365.00 dollars. There was no identified significant increase in the use of alteplase (t-PA), nor significant increase in venous Doppler studies, or removal of CVC lines between the Heparin versus 0.9% normal saline flushing regimes.
• The finding of our intervention supports and validates the ASCO Guidelines and supports evidence for our practice change.