Making the Switch to All Saline Flushes for Chemo Central Lines


After reviewing the evidence, nurses switched from heparin-based flushes to all saline flushes for patients disconnecting chemotherapy at home.

Using a saline-based flush for at-home chemotherapy disconnection tended to be as effective as heparin flushes and did not come with the risk of side effects such as Heparin-induced thrombocytopenia, research shows.

After learning this via a review of the literature and evidence-based practice, a team of oncology nurses at The Ohio State University James Cancer Center & Wexner Medical Center implemented a process to change their discharge kits to all include saline.

Their process for implementing this change was outlined in a poster presentation at the 49th Annual ONS Congress.

“One of the clinical nurse specialists was talking about kits that go home with patients when they're still connected to chemotherapy and have to disconnect at home, and noticed that we had 2 different kits—1 with Heparin in it and 1 without heparin in it,” study author Colleen O’Leary, DNP, RN, AOCNS, EBP-C, LSSYB, associate director of evidence-based practice at The Ohio State University James Cancer Center & Wexner Medical Center, said in an interview with Oncology Nursing News. “So, we looked at the policy for central line flushing—which is actually a pharmacy policy—and it said to use saline in all central lines except implanted ports, it said to use Heparin.”

To enforce the change, the team utilized the ADKAR approach, which stands for:

  • Awareness of the need to change
  • Desire to participate in and support the change
  • Knowledge of how to change
  • Ability to change
  • Reinforcement to sustain the change

In the abstract of her presentation, O’Leary explained, “Change is never easy and is more difficult when it affects a large number. Using an established change management process can alleviate barriers to acceptance of the change and sustainment over time.”

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