Evaluating Normal Saline Locking With Totally Implanted Vascular Access Devices for Patients on 90-Day Maintenance Flushing

BACKGROUND: Heparin has been the preferred locking solution for many organizations for totally implanted vascular access devices (TIVADs). Published data are limited on the use of normal saline alone as a locking solution for TIVAD 90-day maintenance flushing. OBJECTIVES: The purpose of this evidence-based practice initiative was to determine whether locking TIVADs with normal saline alone during a 90-day maintenance flushing protocol resulted in an increase in partial occlusions. METHODS: A clinical team monitored alteplase administration to measure partial occlusions. Prior to heparin deimplementation, nurses maintained TIVADs using 500 units of heparin upon de-access. Infusion nurses received education about published data, pulsatile flushing, and clamping sequences prior to device deimplementation. FINDINGS: Encounters (N = 2,908) during six months of heparin locking were compared to encounters (N = 3,239) during six months of normal saline locking. Data demonstrated minimal variance between locking with normal saline compared to heparin.