Quality in Practice
Switching from heparinized saline flush to normal saline flush for maintaining peripheral venous catheter patency
Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background. The practice of using heparinized saline as a flush fluid for maintaining peripheral venous catheter patency of hospitalized patients in Siriraj Hospital in Bangkok, Thailand is not evidence-based.
Objective. To switch from heparinized saline flush to normal saline flush for maintaining peripheral venous catheter patency in the patients hospitalized to medical wards.
Methods. Study sites were 10 medical wards containing 240 beds. The interventions included (i) disseminating evidence-based clinical practice policy on using flush fluid for maintaining peripheral venous catheter patency to responsible personnel, (ii) reminding the prescribers on using normal saline flush instead of heparinized saline flush, (iii) providing technical advice on using normal saline flush to nurses who encountered peripheral venous catheter clot while using normal saline flush, (iv) confirming a necessity of heparinized saline flush order with the prescriber, and (v) setting up a regulation on marking a special symbol on heparinized saline flush prescription if one really needed heparinized saline flush. The information on using flush fluids was collected from the physicians’ order sheets in the medical records at baseline, every 2–4 weeks during the intervention periods, and at 6 months after launching intervention.
Results. All hospitalized patients in medical wards who had peripheral venous catheter locks received heparinized saline flush in February 2005. The practice was totally switched to normal saline flush in June and November 2005.
Conclusion. The key features critical to success of this implementation are dissemination of evidence-based clinical practice policy and a regulation of having prescriber mark a specific sign right after the heparinized saline flush order.
Keywords: heparinized saline flush, normal saline flush, peripheral venous catheter patency
Address reprint requests to Visanu Thamlikitkul, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. E-mail: sivth{at}mahidol.ac.th
Accepted for publication February 3, 2006.