One area where there seems to much confusion is how we use the words “flushing” and “locking” for all VADs. The INS glossary defines
- Flushing as moving fluids, medications or blood out of the VAD lumen and into the bloodstream. Flushing is used to assess patency of the lumen and to prevention contact between incompatible medications.
- Locking is the instillation of solution in the VAD lumen to maintain patency and to reduce bloodstream infection.
Flushing is done most commonly with normal saline, although a few drugs may be incompatible with saline. In that case, 5% dextrose in water is used to flush the drug from the lumen but saline should be used to flush out the dextrose as this will provide nutrients for growing biofilm.
Solutions for locking a VAD are expanding. Evidence now shows that either normal saline or heparin lock solution produces similar outcomes for locking a central VAD. One solution is not better than the other. Additionally, new antimicrobial lock solutions such as ethanol, citrate, and numerous antibiotic solutions are proving to prevent and treat catheter related bloodstream infection. All studies refer to these as “locking solutions”.
Different purposes, a variety of solutions, different volumes, and locking periods makes this an expanding and complex topic. So flushing and locking are not interchangeable terms. Using the correct word will enhance interprofessional communication.