A central venous access device has a manufacturer-specific order for heparin locking after an intermittent IV medication. Which sequence should the nurse use?
1Heparin lock, medication, saline flush, then a second medication dose
2Medication, heparin lock, saline flush, then clamp without reassessment
3Saline flush, medication, saline flush, then the prescribed heparin lock✓ Correct answer
4Heparin lock, saline flush, medication, then leave the lumen unclamped
Explanation
When a device-specific order requires heparin locking, the sequence is saline flush, administer the medication, saline flush, and then instill the prescribed heparin lock: SASH. The nurse uses the syringe size, flushing volume, technique, and heparin concentration specified for that device and the agency policy. Heparin locking is not universal; many central venous catheters use saline-only locking, so the manufacturer instructions and current order govern practice.
Clinical reasoning The first saline flush confirms patency and clears the lumen, the second saline flush clears medication from the catheter, and the ordered lock solution remains in the device.
Decision rule Use SASH only when the specific device order calls for a heparin lock; otherwise follow the manufacturer instructions and agency policy for saline flushing and locking.
Scenario Adult home health client with an implanted port for chemotherapy; SASH protocol for flushing.
SASH sequence — Saline, administer medication, saline, then heparin lock; this sequence applies when the device-specific order requires heparin locking.
Device-specific flushing policy — Central-line flush and lock solution, volume, technique, and frequency are determined by the device instructions, current order, and agency policy.
10-mL syringe rule — Use larger syringe to limit pressure; smaller syringes can rupture line.