heparin flush

Re: heparin flush

Laura Ringsell — Fri, 14 Aug 2009 10:00:44 GMT

Checked our doses yesterday - i thought we were 0.5 into 100 but actually 1.25ml into 100ml (water for injection) - i feel a major overhaul coming on - another really healthy and very interesting debate...why is it that CPD can be so constructive and yet so destructive at the same time - no wonder the vets ignore me when i come back form CPD full of ideas and plans to re-invent the wheel......

Re: heparin flush

Sal the 1st — Thu, 13 Aug 2009 23:39:20 GMT

thanks for that - I feel that has answered my question very well

Re: heparin flush

sisterscope1 — Thu, 13 Aug 2009 23:18:38 GMT

If it were up to me, I wouldn't bother with heparin at all. There are few studies to suggest it adds anything useful to the process of maintaining "clinical" catheters. Monkeys that have central venous catheters maintained for a year are something else.....

Given heparin is a highly reactive drug and that the potential for developing coagulopathies exists - admittedly seldomly in the healthy patient - there isn't much point in using it, plus it saves you money, which lets face it, can only be a good thing in our current economic climate. Evidence based research has a habit of debunking rituals and sacred cows...

Re: heparin flush

Sal the 1st — Thu, 13 Aug 2009 22:34:23 GMT

perhaps somebody can help me on this one. I have been to two CPDs one was management of the critical patient and another on trauma management (at least one of these within the last year) and the speakers on both of these definitely said that flushing a line with ordinary saline is just as effective as using hep saline with the exception of cases that are known to have a tendency to clot. One of them also mentioned that one of the reasons they stopped using hep saline was because the 'bags' that are made up even very carefully cannot be considered to be sterile and that even before the middle of the working week have the potential to have all sorts of nasties living in them. Now the advice from both of these CPDs regarding hep saline contradicted advice I was given whilst training and also information I got from another earlier CPD (much earlier) ...... So who is right and what should be done at the moment ?

Re: heparin flush

Freckle — Thu, 13 Aug 2009 21:27:42 GMT

so is water for injection a no no? should we be using saline for all reconstituted stuff? (and for hep as well)?

Re: heparin flush

Nick Shackleton — Thu, 13 Aug 2009 21:12:58 GMT

As you can see we make up heparinised saline (using proper bags of saline)

Re: heparin flush

loobylou — Thu, 13 Aug 2009 21:11:55 GMT

No, until you asked that I never twigged!! So is everyone else using water for injection?

Re: heparin flush

Nick Shackleton — Thu, 13 Aug 2009 21:09:54 GMT

THought so lou but your vets aint worried about you injecting that?

Re: heparin flush

loobylou — Thu, 13 Aug 2009 21:09:15 GMT

Water for injection.

Re: heparin flush

Nick Shackleton — Thu, 13 Aug 2009 21:04:59 GMT

what do u use to reconstitue iv drugs that come in powder form lou?

Re: heparin flush

loobylou — Thu, 13 Aug 2009 21:02:48 GMT

We dilute 1250iu heparin into 100ml bags of saline (taken from formulary). We discard after 1 month.
We used to use water for injection but the vets were worried this would cause damage to blood cells?

Re: heparin flush

Nick Shackleton — Thu, 13 Aug 2009 19:42:53 GMT

[quote user="Fluffy"]

we put 0.5ml of the 10000iu heparin into a 100ml water for injection and use it until it's finished - now i am getting worried!

[/quote]

Fluf thats we throw it after a week

Re: heparin flush

Laura Ringsell — Thu, 13 Aug 2009 19:39:00 GMT

we put 0.5ml of the 10000iu heparin into a 100ml water for injection and use it until it's finished - now i am getting worried!

Re: heparin flush

Steph Worsley — Thu, 13 Aug 2009 18:03:39 GMT

I cant remember our dilutions (we use different dilutions in theatre to wards) I shall check tomorrow. However we throw our bags away after 2 days. This is because Glasgow or Edinburgh Uni cultured their hep bags and after 3 days they were getting psuedomonas growth in them no matter how sterile they were.

We draw fresh syringes out of the bag each day so it's easy to grab when you have a drip line being a pain, but a new syringe is used for each patient.

Re: heparin flush

sisterscope1 — Thu, 13 Aug 2009 17:27:36 GMT

We make up bags, 500iu heparin to 500ml 0.9% NaCl which gives 1iu/ml of heparinised saline. There are studies to suggest that very low doses are as effective as higher concentrations. Normal saline on its own has been studied and shown to be as effective in the clinical setting.

We lowered our concentration of hep/saline as we use loads per patient during the course of a procedure. If you've got a very small patient, it is quite easy to accidently overdose the patient.

Our bags are stored for 1 week, we use a needle free port to access the bag to avoid contamination thro' mutliple needle sticks.

Re: heparin flush

Snowb — Thu, 13 Aug 2009 17:00:29 GMT

[quote user="Nick Shackleton"]

We add neat hep to 100ml bags of Sodium Chloride and throw away at the end of every week! We use it at least 10 times a day! As all our patients undergoing GA get an IV catheter we use it all the time. IV caths are flushed after placement and after an meds/induction agents are given. CAn look up the dilutions if you are interested!

I recall that the vials are intended for human use and are therefore to concerntrated for animal patients

[/quote]

if its those vials that are kept in the fridge is it 4iu/ml? 2mls per 500ml bag? been a while so might be wrong. did this when working in hospitals/referrals. but the small vials when working in small practices.

Re: heparin flush

Nick Shackleton — Thu, 13 Aug 2009 16:55:59 GMT

Right just looked up the dilution!

0.5ml of neat Heparin (10000IU/ml) per 100ml bag of saline

Re: heparin flush

Nick Shackleton — Thu, 13 Aug 2009 16:53:20 GMT

I recall that the vials are intended for human use and are therefore to concerntrated for animal patients

Re: heparin flush

xXx Cat xXx — Thu, 13 Aug 2009 15:39:19 GMT

Hi,

We use hep sodium flush and a new vial per patient.

Though we are lucky if we use it once a week then we have a spate of using lots.

Hope this helps.

Tracy

xXx