COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION - Medications POLICY NUMBER: 520 Effective Date: August 31, 2006 SUBJECT: INSERTING A MALE ADAPTOR PLUG (HEPARIN LOCK/SALINE LOCK) 1. DEFINITION:

An intermittent infusion set (heparin lock/saline lock) is an indwelling reservoir in the vein for intermittent infusion therapy when continuous infusion therapy is not indicated. Periodic injections of heparin into the device keep the needle or catheter patent. Note: This procedure is performed by Coalinga State Hospital I.V. Certified Registered Nurses only upon direct order of the Physician.

2. EQUIPMENT:

A. Male Adaptor Plug B. Antimicrobial prep. of povidone-iodine C. Tape and gauze D. Heparin solution/saline solution as ordered by physician E. Syringe for heparin/saline solution. F. Two (2) 3 cc syringes for normal saline G. Disposable gloves

3. PREPARATION OF EQUIPMENT AND INDIVIDUAL:

When continuous infusion therapy has been discontinued/not indicated and there is a need for intermittent infusion therapy for a Individual who has an indwelling over-the needle catheter, a male adaptor plug may be inserted into the catheter to convert it to a heparin lock/saline lock.

NURSING ACTIONS RATIONALE - PRECAUTIONS

A. Check the physician's order.

A. To determine proper authority to initiate heparin lock/saline lock, and medication.

B. Perform hand hygiene.

B. Maintain medical asepsis during procedure.

C. Assemble equipment.

C. Organization helps to expedite procedure.

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D. Perform hand hygiene and put on gloves.

Medical asepsis.

E. Prime the Male Adaptor Plug with normal saline.

F. Close the roller clamp on the infusion set to stop the infusion, and aseptically remove the protective cap from the Male Adaptor Plug. Detach the I.V. tubing, and insert primed Male Adaptor Plug into the catheter hub.

G. When initiating a heparin lock/saline lock when there is not an existing I.V. site, follow N.P. 570. After the venipuncture, advancement of the catheter into vein, and withdrawal of the needle, connect the primed Male Adaptor Plug into the catheter hub.

H. Apply a fresh dressing being certain to keep the injection port outside the air-occlusive tape for quick access.

H. Medical asepsis and access to injection port.

I. Flush Male Adaptor Plug and catheter with prescribed amount of heparin/saline solution.

4. INTERMITTENT INFUSION THERAPY:

NURSING ACTIONS RATIONALE - PRECAUTIONS

A. Three separate syringes A. To insure patency or catheter and to flush male adaptor plug.

B. 2 - 3 cc syringes filled with 2 ml of normal saline with a 25X1 needle

C. One syringe of prescribed heparin solution, unless using saline.

D. Swab the injection port with an antimicrobial skin preparation such as povidone-iodine.

D. Medical asepsis.

E. Insert the syringe containing normal saline and aspirate for blood return to

E. Ensure patency of catheter.

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ensure that the catheter is in the vein. F. Inject 2 ml of normal saline and

remove syringe.

F. Flush heparin from catheter.

G. Attach prescribed intermittent I.V. infusion through Male Adaptor Plug port and infuse at prescribed rate. Observe for adverse reactions to the medication.

G. Intermittent infusion initiated and observe for reaction.

H. Remove intermittent infusion and flush with 2 ml of normal saline (2nd syringe of normal saline).

H. Remove medication, prepare for heparin lock (unless making it a saline lock).

I. Inject the prescribed amount of heparin solution into the Male Adaptor Plug, unless using a saline lock.

I. Ensure patency of next intermittent infusion.

J. Unless another peripheral insertion site cannot be found, the heparin lock/saline lock should be changed every 72 hours.

J. Prevent undue trauma to veins.

5. RECORDING/DOCUMENTATION Follow documentation as outlined in N.P. 571.

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