heparin- waiting 5 minutes

After you cannulate a fistual or graft and give the heparin via the venous line, should you be flushing the arterial with 10cc of NS so it won't clot while you are waiting the 5 minutes for the heparin to take effect? 

Seems logical , but it is not listed as a step in policy that I am aware of- thanks anyone-

Hi there...
In our unit, when we cannulate a fistula, we attach a 10 cc saline syringe to the cannula, aspirate and mix the blood in the cannula, and then flush both lines with the mixed saline/blood.  We then give our heparin and flush it with 10 cc normal saline.  We give the heparin through either arterial or venous since it is systemic and then flush that through with saline.  Hope that makes sense.  This whole thing is such a difficult field to learn.  Wish I could learn it faster. 

Squirl

Jan 25, '07

In our unit, we draw up the heparin bolus with 8cc NS in a 10 ml syringe and flush 1/2 of the solution in each cannualae prior to connecting the patient for dialysis.  Easy and effective. 

Jan 25, '07

When I worked in chronics, we would not attach a syringe to the fistula needles; the heparin would be given through the venous line, and the arterial would simply be allowed to "flash back"; just prior to attaching the arterial blood line, we would prime the arterial fistula needle with blood (by twisting the end cap).  The drawback of this approach (not having a syringe attached to the arterial fistula needle) was that you could not always tell if you had a good stick until you got high arterial pressures; then you still had to get a needle and adjust it while you already had the blood in the system.  But this was company P&P and we had to adhere to it. 

Now in acutes, however, we attach syringes to both fistula needles; after cannulating, we pull back and flush blood (have to be careful not to infuse air!  But we're all RNs).  I think when I'm on my own (and not under constant scrutiny during my orientation), I'll have me a couple of saline syringes ready for the task (a blood/saline solution is much less likely to clot while you're getting started). 

As for the heparin, to my astonishment acute (hospital) nurses are much less worried about (a) giving it at all - we have a lot of discretion, and (b) giving it right at initiation of tx, much less waiting 5 minutes to start.  Interesting how the approaches differ