ALERT: What is required to maintain patency of paediatric CVADs?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
ALERT: What is required to maintain patency of paediatric CVADs?
SITUATION:
This week’s QuickHit! is informed by a safety report documented when a child returned to hospital and their parent reported that a home care nurse taught them to lock their child’s PICC line with normal saline instead of heparin.
BACKGROUND:
Children with medical complexity may be discharged from hospital to home with ongoing care needs for Central Venous Access Devices (CVADs which include Peripherally Inserted Central Catheters [PICCs] and Ports). One of the potential complications of having a CVAD is developing a blockage. Blockages my occur due to formation of a thrombus found within, surrounding, or at the tip of the CVAD catheter.
A blockage may delay treatment or medications from being delivered on time and inconvenience and pose safety risks for children and families if they require a return to hospital to have the line unblocked or replaced. Also of concern is the potential that a thrombus blocking the line could become dislodged and travel to the lungs (pulmonary embolism) causing serious harm.
ASSESSMENT:
Connected Care provides training for family caregivers of children with a CVAD that includes information and education about their prescribed dose of heparin required for daily CVAD locking.
Families who are followed up after discharge describe that they observe variations in CVAD practice from hospital to home care.
Families are taught by Connected Care and reinforced by practice at the bedside:
That heparin is an anticoagulant that prevents the formation of blood clots
Heparin is to be instilled daily when the child’s CVL or PICC is not in use
Prescribed heparin doses are sub-therapeutic and based on a child’s weight
RECOMMENDATION:
In response to this safety report, Connected Care recommended the family resume daily instillations of heparin instead of saline into their CVAD when not being used nor infusing. Connected Care recommends this be the routine practice from hospital to home care as per the order sets developed and included with discharge packages for this specialized paediatric population.
More practice pointers about heparin use in paediatrics:
FOR patients with CVADs <10 kg or those receiving anticoagulation therapy (heparin/warfarin), to maintain sub-therapeutic doses of heparin, devices are not to be heparin locked more than three times per day.
FOR HAEMODIALYSIS/APHERESIS patients, if high concentration heparin is used (greater than 100 units/mL) the heparin MUST be withdrawn to the lumen amount prior to proceeding. For haemodialysis/apheresis catheters only, do not flush heparin or sodium citrate 4% into patient. Withdraw all heparin or sodium citrate 4% from each lumen of catheter prior to any use (e.g. dialysis, apheresis, re-heparinization, flushing).
For more information about heparin locking consult Connected Care Live and click here for more information from AboutKidsHealth
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