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A Randomized Controlled Comparison of Flushing Protocols in Home Care Patients With Peripherally Inserted Central Catheters

Lyons, Margaret G. DNP, RN, CRNI®; Phalen, Ann G. PhD, CRNP, NNP-BC

doi: 10.1097/NAN.0000000000000050

Introduction/Significance/Population: Research has failed to demonstrate an optimal flushing solution or frequency for central catheters. In a 2002 study of 50 000 home care patients, catheter dysfunction with loss of patency was the most common complication and occurred in 29% of the peripherally inserted central catheters (PICCs) tracked. With the advent of the Affordable Care Act and the promise of expanded home care services, this study offers evidence as to a preferred flushing protocol to prevent catheter patency complications for home infusion patients with PICCs.

Methods: This prospective, randomized, 1-way, single-blinded posttest with control group study was performed to compare 3 commonly used flushing protocols in home infusion patients with PICCs. The independent variable was the flushing protocol, and dependent variables included the development of patency-related complications and other significant issues such as sluggishness, occlusion, missed medication doses, catheter replacement, additional nursing visits, and the use of alteplase (Cathflo Activase).

Data Analysis/Results: Each of the study groups had patients who experienced 1 or more patency-related complications. Additional factors that may affect catheter function, including patient age, gender, diagnosis, therapy type, frequency of catheter use, catheter brand/size/number of lumens, concomitant use of anticoagulant medications, and whether PICCs were used for routine lab testing, were analyzed, and no statistical significance was determined. Catheter dwell time (catheter days) was statistically significant (p = .003, confidence interval = 95%; assuming equal variance) and confirmed the assumption that the longer a home care patient's catheter was in place, the more complications occurred. There were no cases of heparin allergy, heparin-induced thrombocytopenia, or line infection.

Discussion/Conclusion/Recommendations for Practice: The data provide some evidence to support the elimination of heparin flushing in home care patients with PICCs, although data in the saline-only group that related to additional registered nurse visits to assess PICC patency and the use of alteplase (Cathflo Activase) were trending toward significance because this group experienced a higher incidence of these complications than both the heparin groups. These findings should not be translated to home care patients with cancer or pregnancy diagnoses because these populations were excluded from this study. More studies of this topic area should be initiated. Please see video abstract, Supplemental Digital Content 1, for more information (

Supplemental Digital Content is Available in the Text.

Villanova University College of Nursing, Villanova, Pennsylvania (Dr Lyons), Thomas Jefferson Home Infusion Service, Philadelphia, Pennsylvania (Dr Lyons), and Thomas Jefferson University School of Nursing, Philadelphia, Pennsylvania (Dr Phalen).

Margaret G. Lyons, DNP, RN, CRNI®, is the Nurse Faculty Coordinator for the RN-BSN Online Program at Villanova University College of Nursing, Villanova, PA, and is a per-diem staff nurse for Jefferson Home Infusion Service in Philadelphia, PA. She maintains her infusion nursing certification and is active in the Pennsylvania State Nurses Association and the Infusion Nurses Society. She has published and presented on a variety of nursing topics.

Ann G. Phalen, PhD, CRNP, NNP-BC, is the Associate Dean for Undergraduate Programs at Thomas Jefferson University, School of Nursing. She teaches in the Doctor of Nursing Practice (DNP) program and coordinates clinical courses for the Neonatal Nurse Practitioner program track. She remains active in the clinical practice arena as well as in her specialty organizations and has published numerous articles and presented on various topics.

Corresponding Author: Margaret G. Lyons, DNP, RN, CRNI®, Driscoll Hall Room 222, 800 Lancaster Avenue, Villanova, PA 19085 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

The authors of this article have no conflicts of interest to disclose.

© Copyright 2014 by Infusion Nurses Society