# A nurse is flushing a CVAD between medication doses using a heparin-locked port. Which procedure correctly applies the SASH protocol?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391890&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse is flushing a CVAD between medication doses using a heparin-locked port. Which procedure correctly applies the SASH protocol?

## Option

1. Saline → Administer medication → Saline → Heparin (S-A-S-H), using 10-mL syringe to limit pressure **✔ Correct answer**
2. Use 1-mL syringe to push faster
3. Heparin → Saline → Medication → Saline
4. Medication only, no flushing

**Correct answer: 1**

## 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.

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