Implementation of an Evidence-Based Practice Change Removing Heparin From Implanted Vascular Access Devices

Area of Science:

• Nursing Practice
• Vascular Access Device Management
• Evidence-Based Practice

Background:

• Heparin has been a standard flush solution for implanted vascular access devices (IVADs).
• Concerns exist regarding heparin's potential risks and the need for effective alternatives.
• Literature suggests saline may be a viable alternative for IVAD maintenance.

Purpose of the Study:

• To describe the implementation and outcomes of removing heparin from IVAD management.
• To evaluate the effectiveness of 0.9% sodium chloride as a replacement flush solution.
• To assess the impact on alteplase administration rates post-implementation.

Main Methods:

• Conducted an extensive literature search and appraisal to identify best practices.
• Implemented a nurse-led initiative to replace heparin with 0.9% sodium chloride for IVAD deaccessing.
• Utilized a pulsatile flushing technique with saline.
• Monitored alteplase administration rates as a key performance indicator.

Main Results:

• Successfully removed heparin from the IVAD deaccess protocol.
• 0.9% sodium chloride with pulsatile flushing proved effective in preventing occlusion.
• No statistically significant change in alteplase administration rates was observed 6 months post-implementation.

Conclusions:

• 0.9% sodium chloride alone is effective for IVAD lock maintenance.
• This evidence-based practice change demonstrates a safe and effective alternative to heparin.
• The findings support the use of saline for IVAD management, potentially reducing medication-related risks.