Transitioning from heparin to saline locks for central venous access devices in oncology: An evidence-based practice approach

Terri Jabaley; Niya Xiong; Susanne Conley; Teresa Mazeika; Danielle Johnson; Brenda A Biggins; Nancy Hilton; Fangxin Hong

doi:10.5737/23688076322286293

Transitioning from heparin to saline locks for central venous access devices in oncology: An evidence-based practice approach

Can Oncol Nurs J. 2022 Apr 1;32(2):286-293. doi: 10.5737/23688076322286293. eCollection 2022 Spring.

Authors

Terri Jabaley¹, Niya Xiong², Susanne Conley³, Teresa Mazeika⁴, Danielle Johnson⁴, Brenda A Biggins⁵, Nancy Hilton⁶, Fangxin Hong⁷

Affiliations

¹ Clinical Inquiry Specialist, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, MA.
² Statistician, Department of Data Science, Dana Farber Cancer Institute, Boston, MA.
³ Oncology Clinical Specialist, Dana Farber Cancer Institute, Boston, MA.
⁴ Nurse Director, Dana Farber Cancer Institute, Boston, MA.
⁵ Staff Nurse, Dana Farber Cancer Institute, Boston, MA.
⁶ Clinical Director, Lifespan Comprehensive Cancer Center at Newport Hospital, Newport, RI.
⁷ Faculty Statistician, Department of Data Science, Dana Farber Cancer Institute, Boston, MA.

Abstract

Central vascular access devices (CVADs) are often essential to the care of patients undergoing long-term cancer treatment. CVAD maintenance is an essential oncology nurse competency. Evidence-based practice (EBP) in flushing and locking help to prevent intraluminal occlusion, a common complication. Heparinized saline (HS) has been the standard locking solution for CVADs. However, research indicates no superiority of HS over normal saline (NS). The objectives of this EBP project were 1) to evaluate whether a significant difference in intraluminal occlusion was associated with the change from HS to NS use for locking CVADs in ambulatory oncology care, and 2) to evaluate the effects of peer nurse mentoring on nurses' and patients' perspectives about the practice change. Analysis of data revealed decreases in alteplase usage after transitioning to NS locking. Patient and nurse surveys indicated that peer nurse mentoring increased nurse and patient confidence and competence in making the practice transition.