INFU
S I O N S P OT L I G H T
Infusion Spotlight focuses on
a topic of interest unique to
the infusion community. Each
issue will bring a different
infusion topic to light.
FLUSHING AND LOCKING
Q: Could you please advise regarding the recommended locking for an implanted
port if accessed and then not used for 24 hours or more? Should we use
10 units/mL of heparin or 100 units per mL?
A: If not being used for more than 24 hours, accessed nonvalved implanted ports
can be flushed and locked 1-2 times per week using 3-5 mL 100 units/mL
heparin, and valved implanted ports can be flushed and locked at least weekly
with 3-5 mL 100 units/mL heparin.
Q: What is the standard of care of any central venous access device (CVAD) if it
flushes easily with an assessment of no swelling or pain, but you do not have a
blood return? Can you use this device to infuse medications?
A: The continued use of a CVAD without a positive blood return is not
recommended due to the possibility of malposition or tip migration, which
may occur at any time during the catheter dwell time. Verification by chest
radiograph should be performed.
Q: Are there any reported incidences of an implanted port that is radiographically
functioning but still unable to get a blood return when accessed?
A: There is no supporting literature citing the use of an implanted port without a
positive blood return. There may be a problem with positioning of the p atient
when attempting to obtain a blood return, or the tip may have migrated.
Collaborate with the health care team as to risks and benefits to the patient in
the continued use of the implanted port.
Q: Does INS have recommendations as to how often and what amount of saline
to use when flushing peripheral locks, peripherally inserted central catheters
(PICCs), and other central catheters?
A: Vascular access devices should be flushed with preservative-free 0.9% s odium
chloride (USP) (saline) between the administration of incompatible medications;
after blood draws; any time there is blood noted within the device; and as
directed by the manufacturer. The minimum flush volume should be equal to at
least twice the volume of the catheter, plus the volume of any add-on devices.
Q: Can a heparin-impregnated venous catheter cause heparin-induced
thrombocytopenia (HIT)?
A: Any exposure to heparin may cause HIT. For more information on HIT, see the
Clinical Concepts column in the September/October 2009 INS Newsline.
Q: With how many mLs of sodium chloride should you flush an over-the-needle peripheral catheter and
how often?
A: Flush any peripheral vascular access device with a minimum of 2 mL preservative-free 0.9% sodium chloride
(USP) after each use or at least every 12 hours.

Q: Should 3-5 mL of blood be withdrawn and discarded from an implanted port each time it is accessed to
prevent the heparin lock solution from being injected into the bloodstream?
A: It isnt necessary to withdraw and discard blood when a CVAD has been locked with heparin in a
concentration of 100 units/mL or less, but it would be necessary if the concentration was greater than
100 units/mL.

Q: When considering flushing of central catheters for patients in the neonatal and pediatric intensive care unit,
is there an age limit when figuring the minimal amount to flush? The guideline is internal volume x 2, but our
units want a specific age associated with this formula.
A: No, there is no age limit. The amount is determined, as you have noted, by the internal volume of the vascular
access device.

Q: When an implanted port is accessed and the patient is performing home hydration every other day, is it
acceptable to flush the catheter with heparin only when not infusing, or is it recommended to flush with
saline and heparin?
A: According to the INS Flushing Protocols, an accessed implanted port should be flushed after each use or
at least 1-2 times per week. Flush with 5-10 mL of sodium chloride 0.9% (USP) (saline) and lock with
3-5 mL 100 units/mL heparin.

Q: What concentration of heparin should be used when flushing a nonvalved PICC and how often should
it be flushed?
A: A heparin lock solution of 10 units/mL is the preferred lock solution used to lock a nonvalved PICC. A
nonvalved PICC is flushed and locked after each intermittent use and at least every 24 hours when not in use.

The questions and answers contained in Infusion Spotlight have been selected from the thousands of
clinical questions we have received through the INS Knowledge Centers Clinical Nursing Forum. To search our
extensive database of clinical questions, please visit the Clinical Nursing Forum in the INS Knowledge Center at
http://www.knowledge.ins1.org.

BIBLIOGRAPHY
Gorski L, Perucca R, Hunter MR. Central venous access devices: care, maintenance, and potential complications. In: Alexander M, Corrigan
A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St. Louis, MO: Saunders/Elsevier; 2010: 495-515.
Infusion Nurses Society. Flushing Protocols. Norwood, MA: INS; 2008 (rev. 2011).
Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2011;34(1S): S59.
Infusion Nurses Society. Policies and Procedures for Infusion Nursing. 4th ed. Norwood, MA: INS; 2011:81-94.

Copyright 2012 by the Infusion Nurses Society, Inc. All rights reserved. No part of this article may be reproduced without written permission from
the Infusion Nurses Society.

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