Flushing a central venous catheter (CVC) is a critical nursing procedure that maintains catheter patency, prevents clot formation, and reduces infection risk. It’s performed using sterile technique and typically involves saline and/or heparin flushes, depending on the type of catheter and institutional protocol.
Purpose
- Prevent occlusion from blood or medication residue
- Maintain patency between infusions
- Reduce risk of central line-associated bloodstream infections (CLABSIs)
- Confirm catheter function before us
Flush Solutions & Volumes
| Catheter Type | Flush Solution | Volume | Frequency |
|---|---|---|---|
| PICC Line | 0.9% Normal Saline ± Heparin (10–100 U/mL) | 5–10 mL | Every 12–24 hrs or after use |
| Tunneled CVC (e.g., Hickman) | Saline + Heparin (100 U/mL) | 10 mL saline + 3–5 mL heparin | Every 24 hrs or per protocol |
| Implanted Port | Heparin (100–500 U/mL) | 5 mL | Every 4 weeks if not in use |
Always use a 10 mL syringe to avoid excessive pressure that could damage the catheter.
Articles
A tray containing:
- Betadine swabs or solution.
- Alcohol swabs or solution.
- Syringes 10 mL size.
- Ampoule of heparin flush (heparin 100 U/mL in saline) or vial of normal saline according to institution policy
- Sterile needle (20-22 gauge).
- Sterile gloves.
- Face mask.
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Explain to client the rationale for flushing the catheter. | Reduces anxiety and enhances cooperation. |
| 2 | During procedure Wash hands and put on gloves. | Reduces transmission of microorganisms. |
| 3 | Prepare two syringes, one with 10 mL normal saline and another with 5 mL heparin flush solution. | Preparing articles in advance allows for smooth performance of procedure. |
| 4 | Swab injection cap or hub with betadine and alcohol. | Prevents introduction of microorganisms into catheter. |
| 5 | Clamp catheter and remove cap. | Prevents air entry into catheter. |
| 6 | Check catheter for patency: Attach syringe with normal saline. Release clamp. Aspirate old heparin solution from the catheter and observe blood return. Flush quickly with normal saline and reclamp. Remove empty syringe. | Opens catheter lumen and ensures patency of the catheter. |
| 7 | Flush with heparin solution quickly. Attach syringe filled with 5 mL heparin solution catheter. Release clamp. Flush quickly and reclamp. | |
| 8 | Place new cap on end of catheter, tape all tubing connections, and attach tubing to clients clothing. | Maintains sterile seal to catheter. |
| 9 | Dispose off soiled articles and supplies, clean and replace reusable articles. | Reduces transmission of microorganisms. |
| 10 | After procedure Wash hands. | Reduces transmission of microorganisms. |
| 11 | Document in nurses’ notes the procedure with time and observations made. | Communicates with other health professionals. |
Special Considerations
- Flush before and after medication administration
- Flush every 12 hours if not in use (or per facility protocol)
- Use 10 mL syringes to avoid excessive pressure
- Never reuse syringes or touch sterile tips
- Monitor for pain, swelling, or resistance
Geriatric variation
If the patient is fluid compromised, adjust the volume of fluid flushes.
Paediatric variation
Be sure to reduce the volume of fluids used to aspirate and to flush the catheter.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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