1. Safety of Decreased Heparin Flush Concentration During Peripheral Blood Stem Cell Collection Rose Batiste RN, MSN, AOCN Mary Brush RN, MS, AOCN Cathy Del Sarto RN Ursula Dolan RN, BSN, OCN Donna Kare RN, CRNI Karen Kiley RN, MS, AOCN Monika Payan APRN, BC-APN Nancy Porter RN, MS, AOCN Tulio Rodriguez, MD Patrick Stiff, MD Amir Toor, MD Miriam Volle RN, MSN, ACNP, OCN Sheila Wojtowicz RN, BSN, OCN

2. PROJECT AIM: To validate the safety of a decreased concentration of heparin flush used in management of double lumen Vaxcel Plus apheresis central venous catheters (CVC) in autologous stem cell transplant patients To simplify CVC management for patients and their caregivers by using commercially available pre-filled heparin flush syringes

3. MEASURABLE GOALS: RATES OF COMPLICATIONS OF: Apheresis Flow Rate Problems Fibrin Sheath Development DVT

4. RESULTS No apheresis flow rate problems were identified

5. Main complication involves # of patients who required use of TPA for suspected fibrin sheath development Median # of catheter days for suspected fibrin sheath was 49 days, and the mean was 61 days Preliminary findings indicate increased TPA use at 30 days post CVC insertion Cost analysis shows it is more economical to utilize heparin or Coumadin than to administer TPA

6. 1 Patient developed a DVT Coumadin 2mg PO daily was given as standard DVT prophylaxis until the platelet count was below 70,000 UL

7. IMPROVED SAFETY Utilizing commercially available pre- filled heparin flush syringes Simplifies CVC management for patients and their caregivers Reduces the risk of administration errors

8. NEXT STEPS Median # of days from catheter insertion to date of complication was 30 days & mean was 43 days, therefore it may be reasonable to reinstitute prophylactic Coumadin therapy upon engraftment of these patients Complications will continue to be monitored over time Evidence found in this study will allow for continued use of lower concentration heparin flushes