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Infusion Master - NHIA

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Exhibit 1Occlusion Rates Before and After New Heparin Flush ProtocolsTime Period PICC Lines Occlusions Occlusion RateBefore (2/19/2006 – 2/18/2007) 277 9 3.25%After (2/19/2007 – 2/18/2008) 329 8 2.43%Source: University of Iowa Community HomeCareData collection is key to understanding the outcome of a change in clinical procedures, andsharing this information contributes to the body of home infusion clinical knowledgeJ A N U A R Y / F E B R U A R Y 2 0 0 9comes throughout and following the heparin concentrationchange. We were encouraged by the fact thatwe had no increase in occlusion rates of CVCs followingthe transition, which we defined as a line thatwill not aspirate or flush (see Exhibit 1). In addition,we have not received any reports of patients diagnosedwith HIT since we made the change. We willcontinue to use the 10U/mL heparin, as we evaluatethe feasibility of a change to saline-only flushes.ConclusionThe concentration of heparin used to routinely flushvascular access devices must be carefully evaluated inlight of the risk for heparin-induced thrombocytopeniain susceptible patients. In the absence of home infusionbased clinical research, providers are encouraged toexamine their internal patient outcomes in the applicationof evidence-based research from the hospital setting.Data collection is key to understanding the outcomeof a change in clinical procedures, and sharingthis information contributes to the body of home infusionclinical knowledge.Kelli Krutsinger, R.N., B.S.N., C.R.N.I. ® , is the Nurse Manager atUniversity of Iowa Community HomeCare. She can be reached byphone at (319) 337-8522 or by e-mail at krutsingerk@healthcare.uiowa.edu.References1. Franchini, Massimo. Heparin-induced thrombocytopenia:An update. Thrombosis Journal.2005;(14).2. McNulty I, Eliezer K, Kim K. Thombocytopenia followingheparin flush. Progress in CardiovascularNursing. 2007; 20(4): 143-147.3. Swanson, Joseph. Heparin-Induced Thrombocytopenia.Journal of <strong>Infusion</strong> Nursing. 2007; 30(4): 232-240.4. Warkentin TE. Platelet count monitoring and laboratorytesting for heparin-induced thrombocytopenia.Arch Pathol Lab Med. 2002; 126: 1415-1423.5. Baroletti SA, Goldhaber SZ. Heparin-inducedthrombocytopenia. Circulation. 2006; 114:e355-e356.6. Gettings E, Brush K, VanCott E, Hurford W.Outcome of postoperative critically ill patients withheparin-induced thrombocytopenia: An observationalretrospective case-control study. Crit Care.2006; 10(6): R161.7. Laster JL, Nichols WK, Silver D. Thrombocytopeniaassociated with heparin-coated catheters inpatients with heparin-associated anti-platelet antibodies.Arch Internal Med. 1989; 149:2285-2287.8. <strong>Infusion</strong> Nurses Society (INS). <strong>Infusion</strong> NursingStandards of Practice. 2006; 29; S56.24

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