A nurse is flushing a CVAD between medication doses using a … | MyMerci
Medical EmergenciesPA
Question
A nurse is flushing a CVAD between medication doses using a heparin-locked port. Which procedure correctly applies the SASH protocol?
1Saline → Administer medication → Saline → Heparin (S-A-S-H), using 10-mL syringe to limit pressure✓ Correct answer
2Use 1-mL syringe to push faster
3Heparin → Saline → Medication → Saline
4Medication only, no flushing
Explanation
Correct (2): SASH protocol for heparin-locked CVADs: Saline → Administer medication → Saline → Heparin. 10-mL or larger syringe generates lower pressure (smaller syringes can rupture line). Saline flushes only for valved or saline-locked devices. Pulse/push-pause technique helps clear residual drug. (1) Wrong order. (3) Risk of clot. (4) Small syringe ruptures.
In-depth explanation
Memory Tip SASH = "Saline·Administer·Saline·Heparin." Use ≥10-mL syringe. Valved devices (PowerPICC) only need saline. Implanted ports also need monthly heparin flush when not in use.
Clinical scenario
Scenario Adult home health client with an implanted port for chemotherapy; SASH protocol for flushing.
Key concepts
SASH protocol — Heparin-locked central line flushing sequence: Saline-Administer-Saline-Heparin.
Pulse-push-pause flushing — Intermittent flushing technique to enhance clearance of residual drug.
10-mL syringe rule — Use larger syringe to limit pressure; smaller syringes can rupture line.