| Sumario: | Significance & Background: Oncology patients often require central lines for treatment purposes.1 Central line flush practice can affect central line patency.2 Nurse led research in the organizations hospitalized bone marrow transplant adult patients with peripherally inserted central catheters (PICCs) found using normal saline (NS) maintained line patency as effectively as NS and heparin 100 units/milliliter(mL).3 These findings align with meta-analyses suggesting using NS and heparin is not superior to using NS alone.4-10 Deleting heparin from flush protocols shields patients from adverse effects such as heparin-induced thrombocytopenia and hypersensitivity reactions. Since NS is less expensive than heparin, it saves organizational money through direct cost and indirect cost like nursing and pharmacy labor.11-14. Purpose: The purpose of the ongoing evidence-based practice (EBP) project is to change flush practice for adult patients with PICCs, ports, and central lines that historically use low dose heparin (100 units/mL) with aim to increase patient safety, decrease organizational cost, and to examine outcomes. It excludes patients with lines that use heparin 1,000 units/mL and pediatric patients. The EBP change is occurring organizationally. This abstract discusses preliminary results in hospitalized adult oncology patients. Interventions: Working with Nursing and Pharmacy leadership, Shared Governance, Nursing Education, Patient Education, Policy and Procedure, and Informatics, the EBP change to pulsatile flushing with only NS occurred in December 2024. Alteplase 2mg/mL, a tissue plasminogen activator product, is used to clear lines with partial occlusions (line flushes but does not return blood) or full occlusions (line does not flush or return blood). The number of Alteplase doses administered can be used as a proxy measure to determine the number of line occlusions.14. Results: Preliminary data in the 96-bed oncology patient population indicate Alteplase 2mg/ml utilization increased when comparing 6 months pre-implementation EBP change to 6 months post-implementation EBP change. Discussion: Researchers report occlusion rates in various manners.15, 16 Methods include (1) the cumulative percentage rate per line and (2) incidence rate per 1,000 central line days (CLDs). The preferred method is incidence rate per 1,000 CLDs because this normalizes differences in patient populations and catheter dwell time. The EBP team is working with the Central Line Committee, Data Analysts, Pharmacy, and Informatics to determine the incidence rate per 1,000 CLDs, first for the oncology units, then for the hospital. Additionally, work to determine cost ramifications continues.
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