A patient with a long-term vascular access device is in cardiac arrest and requires epinephrine. To remove heparin from the device, the paramedic should:

The correct approach in this scenario is to withdraw up to 10 mL of blood and discard it. This procedure is crucial for ensuring that heparin, which may be present in the vascular access device, does not interfere with the administration of epinephrine during cardiac arrest. By discarding a volume of blood from the device, the paramedic effectively removes any residual heparin and reduces the risk of complications associated with anticoagulation during the emergency intervention.

Flushing the vascular access device with saline, while it may clear the device of many substances, does not guarantee the complete removal of heparin. Simply flushing with saline could inadvertently mix the heparin with the medication being administered, which is particularly concerning in a cardiac arrest situation where precise dosing and drug interactions are critical. Additionally, injecting sodium bicarbonate is not appropriate for this purpose and can lead to other complications in the context of cardiac arrest. Finally, while following up epinephrine with a saline flush is good practice to ensure that medication is delivered effectively to the circulation, it does not address the presence of heparin beforehand.