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Protocols for Flushing a CVAD

Central venous access devices (CVAD) are thin, flexible, hollow tubes inserted by emergency medical technicians to save lives. CVADs infuse needed coagulant continuously to hemophilia patients, but CVADs are also a direct route into the bloodstream for Methicillin-resistant Staphylococcus aureus (MRSA). One in 20 CVADs becomes infected, and 12.5 percent of the catheter-related bloodstream infections (CRBSI) are fatal. The Centers for Disease Control (CDC) specify protocol for flushing CVADs for proper CVAD site maintenance.

  1. Catheters and Ports

    • Two classes of CVADs are catheters and ports. A catheter, inserted into one of the peripheral veins in the upper arm, is a long plastic tube that keeps chemotherapy medications from touching and damaging skin and muscle tissue. The catheter ends the discomfort of repeated injections. Ports carry chemotherapy to cancer cells, infuse antibiotics to severe infections, and allow technicians to draw blood. Continuous infusion of coagulation therapy through a CVAD is a stable infection-free method to maintain stable blood homeostasis in hemophilia A and B patients. Continuous infusion of coagulant is superior to injections of coagulant. Ports surgically implanted into the subclavian or jugular vein may be attached to a fluid reservoir in a surgically created subcutaneous pocket in the upper chest or arm.

    Preventing Infection

    • The CDC protocol for eliminating CRBSI is prevention. Both the practitioner's and the patient's skin must be scrubbed with chlorhexidine gluconate before inserting or examining the CVAD. Povidine and iodine are not as effective as chlorhexidine gluconate. The intravenous line must be cleaned and examined daily. Unnecessary CVADs must be removed promptly. The California Hematology Oncology Group reminds patients to keep appointments to flush continuous infusion ports, or pumps, with regular sterile saline at least once a month.

    Healthcare-Associated Infections

    • A facility's infection rate may be compared to the national rate in the CDC's Healthcare-Associated Infections database. Medicare and medicaid services no longer reimburse hospitals for CRBSIs that occur after hospital admission. The cost per infection is $34,508 to $56,000. Antimicrobial-coated CVADs are coated with chlorhexidine /silver sulfadiazine or minocycline/rifampin to prevent CRBSIs. Routine use of antimicrobial catheters increase the risk of resistance to antibiodics. National Institutes of Health report use of heparin in infants and children's IVs.

    Flushing CVADs

    • Continuous infusions must be flushed once per shift while the patient is in a hospital. Prior to each access, change in device, or when blood is observed in the tube, the CVAD must be flushed. The CVAD must be flushed between different medications and after transfusions. Intermittent access infusions must be flushed on conversion from continuous to intermittent access. The CVAD must be flushed prior to each access, prior to and following each medication, and with any change of devices.

      Healthcare providers and insurance companies have their own protocols based on CDC standards, but the National Institutes of Health report from numerous studies on heparin versus .9 percent salt solution flushes. NIH reports no evidence that heparin flushes are more effective than saline flushes in preventing infections.

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