Recent systematic reviews and meta-analyses have found that there is no advantage to flushing central venous catheters (CVCs) with heparin compared with flushing them with normal saline.  However, evidence that shows the same benefit in the pediatric patient population is insufficient.

Researchers based in Hawaii sought to determine the effectiveness of a new standard flushing practice using normal saline, the safety of decreasing heparin use, and the financial impact of using heparin. To do this, they implemented a quality improvement project with pediatric patients receiving care at the Kapi’olani Medical Center for Women and Children in Honolulu. The results were published in the Clinical Journal of Oncology Nursing.

As part of the project, changes in CVC flushing were implemented in September 2020 and data was collected for 5 months. Sixty-two pediatric patients with cancer were included. The new flushing guidelines included a saline lock for all tunneled lines. In the inpatient setting, tunneled lines were flushed with the new push-pause method every 12 hours (twice daily), allowing each shift to complete their line assessment. In the outpatient setting, saline lock with the push-pause method was used while undergoing care in the unit and in those patients receiving daily infusions who elected to keep their port in place.

Continue Reading

“The implemented heparin lock changes occurred with deaccess of a port and at the time of discharge for all external tunneled catheters,” the researchers explained. Heparin dose also was decreased from 3 mL (100 units/mL) to 2 mL (10 units/mL) for tunneled catheters, but ports remained the same 5 mL (100 units/mL), flushing only at the time of deaccess.

“This limited process improvement project was able to show the effectiveness and safety in the use of normal saline flushing and decreased heparin dose flushes to maintain tunneled CVC patency in the population of pediatric patients with cancer,” the researchers concluded. “This was evidenced by no statistically significant change in alteplase use recorded postimplementation.”

Heparin is more costly than saline, so reducing its use saved money for patients and their families. However, the new process was a significant change in clinical practice for the nurses involved. Nurses underwent training prior to the change and ongoing education and reinforcement throughout the patients’ care.

This study was limited by its sample population size, as the participating medical center is the sole pediatric oncology hospital in Hawaii. Additionally, data was only collected for 5 months; a longer period of time could generate a larger sample size and more data.


Omatsu DA, Thompson K, Maglasang B, Yuasa H, Kimata C. Heparin versus normal saline: flushing effectiveness in managing central venous catheters in pediatric patients with cancer. Clin J Oncol Nurs. 2022;26(3):300-307. doi:10.1188/22.CJON.300-307