Our Lady of the Lake College

NURS 3310 PICOT Question Worksheet Our Lady of the Lake College Student Name:


POPULATION: patients receiving in-home care


INTERVENTION: flushing regimens comprising both heparin and saline are used.


COMPARISON: heparin-only flushing regimens versus heparin-and-saline regimens


OUTCOME: Complication prevention (fewer problems) during catheter replacement


TIME FRAMEWORK: TWO WEEKS


PICOT Question: How do heparin flushing regimes compare to those containing heparin and saline in the prevention of problems PICC line during catheter change over a two-week period in patients with a PICC line undergoing home care?


Date/Time


Database


Search Restrictions


Search Number of Search Results


Usefulness of search & impact on next search strategy


28th Jan. 2017


CINAHL


Full-text


Peer-reviewed


Publication Date (within 5 years)


English Language


Journal Subset - Nursing


Publication Type - Research


Central venous catheters. Central venous catheter thrombosis,


124


This research was used to show the controversy over the advantages and disadvantages of the various flushing solutions. I used the research by Infusion Nurses Society (2006) to show the importance of PICC lines especially in home care patients.


28th Jan. 2017


Pubmed


Full-text, peer reviewed


PICC, Homecare, central venous catheters


254


This study was used to confirm that when catheters are used intermittently, they tend to have a prolonged patency especially when heparin is used. The study by Rabe et al., (2008) is necessary in confirming the importance of prolonged patency in PICC lines.


28th Jan. 2017


Cochrane database of systemic reviews


Full-text, peer reviewed


PICC, Saline solutions


502


This study was used to show that there are no major differences in the outcome of patients when a mixture of saline and heparin is used for flushing. The rate of occlusion is still the same. This research is necessary for comparison of the use of heparin and saline solutions in flushing (Schilling et al., 2006)


28th Jan. 2017


National Guideline Clearing House


Full-text, peer reviewed


Heparin-sodium solutions, PICC, Prevention PICC complications, homecare


31


This study was used in the confirmation of the fact that the concentrations of heparin do not affect the potency of catheters. However, when a mixture of both heparin and saline were used, then the rate of infection is much lower. The study by Hoffer et al., (2009) confirms the PICOT question.


28th Jan. 2017


Pubmed


Full-text, peer reviewed


Flushing, PICC, Heparin, Saline, homecare, heparin flushes


173


This study shows that there is a 6% occlusion rate when using saline during flushing and a 0% occlusion rate when using a mixture of saline and heparin (Bowers et al., 2008).


Essay


Drawing blood from a PICC line is necessary in some instances, but it should be done using specific steps and completely aseptic procedures. It is important to always take a lot of precaution considering that there is a high risk of the formation of blood clots (thrombosis) and infection among other problems. This is why most hospitals discourage the use of a PICC line in obtaining blood from a patient. It is immensely important to keep in mind that every procedure requires prior knowledge and expertise. In patients undergoing homecare and under infusion, it is expected that flushing procedures using a mixture of heparin and saline will produce less complications than when applying solution containing heparin alone. It may not be inappropriate to draw blood from a PICC line but it is necessary to have knowledge on handling of this procedure for it to take place successfully and without any problem.


Today, many patients are opting for therapies that take place in the home and this makes homecare more complicated. Chemotherapy, liquid infusions, antibiotics and nutrition necessitate the application of a central venous line on patients. PICC’s are normally chosen for this function because of their numerous advantages including the fact that they are less invasive, they are cheaper and they have lower complications arising from their insertion (Bowers et al., 2008). As a way of maintaining patency of catheters and reducing drug interactions, PICC lines are normally flushed with saline and locked with a mixture of saline and heparin. Research has shown that heparin may not be necessary in the maintenance of the patency of most intravenous lines. A pertinent question arising from this fact is whether heparinized saline would be necessary in maintenance of PICC lines (Hoffer et al., 2009).


An extensive research using the PICOT question was conducted for this paper. Articles describing the flush protocols applied in the maintenance of PICC’s were targeted. Numerous studies confirm that there is a high possibility of a patient developing complications such as thrombosis when a solution containing heparin alone is used as compared to that containing heparin and saline (Infusion Nurses Society, 2006). Others such as \bowers et al., (2008) confirmed that there is no difference when saline alone is used than when saline and heparin are used together. However, the same authors confirm that there is a major difference in the occlusion rate and this prompts the use of heparin as well as saline so as to cut costs of treating the resulting complications. Considering that all institutions are concerned with giving their patients the best care for less cost, it is important to use a solution containing both heparin and saline.


References


Bowers, L., Speroni, K., Jones, L., & Atherton, M. (2008). Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure luer-activated devices. Journal of Infusion Nursing, 31(1), 22-27.


Hoffer, E., Borsa, J., Santulli, P., Bloch, R., & Fontainne, A. B. (2009). Prospective randomized comparison of valved versus nonvalved peripherally inserted central vein catheters. American Roentgen, Ray Society, 173, 1393-1398.


Rabe, C., Graman, T., Sons, X., Sons, X., Berna, M., Gonzalez-Camona, M. A., & Klehr, H. et al., (2008). Keeping central venous lines open: A prospective comparison of heparin, vitamin c and sodium chloride sealing solutions in medical patients. Intensive care medicine, 28, 1172-1176.


Schilling, S., Doellman, D., Hutchinson, N., & Jacobson, D. (2006). The impact of needles connector device design on central venous catheter occlusion on children. JPEN, 30(2), 85-90.


Infusion Nurses Society. (2006). Infusion nursing standards of practice. Journal Infusion of Nursing, 29(1 Suppl), S1.

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