There was an FDA warning several years ago about NOT using concentrated
sodium citrate as a catheter lock solution because of some deaths. I don't
know how easy it is for your pharmacy to get you the less concentrated
solution. If that is too difficult or costly, I would recommend using
Cathflo to lock each lumen. NS only for dialysis catheters won't work
because of flow issues with dialysis. Some of the needleless connectors
(CLC 2000, InVision Plus, MaxPlus, among others) have FDA approval for NS
flush/lock, but these are for non-dialysis central venous catheters.
Fibrin will still build up around the openings of catheters, and will impede
flow for dialysis (ideally want up to 400 mls /minute blood flow).
I've talked with numerous dialysis centers that has used Cathflo when a
patient has HIT. I'd try to get insurance approval upfront. Very
expensive, but will save having to exchange a dysfunctional catheter and
unnecessary delays with problem-solving catheter obstruction/dysfunction.
Call Genentech's drug info number. They can give you the reference for the
Schenk article. Basically it had 12 patients, only 8 of whom completed the
study period of 4 months. Each patient was their own control. They had
their dialysis catheter locked with heparin 1,000 units/ml, catheter fill
volume, after dialysis treatments, OR alteplase 2 mgs/2 mls per lumen, for 2
months, and then switched to the other locking solution for 2 months. On
the alteplase arm, the patients all had better dialysis outcomes, fewer
thrombotic complications, with no adverse reactions. The main barrier is
cost.
Nadine Nakazawa, RN
PICC Program Coordinator
Stanford Hospital
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Subject: Dialysis catheters and sodium citrate
Date: Wed, 21 Jun 2006 22:46:23 -0500
My last question was about using sodium citrate, instead of heparin,
for CVC. The catheter in use is a hemodialysis catheter.
The patient has TTP (thrombotic thrombocytenia purpura) and has a
tunneled hemodialysis catheter. The patient had plasmapheresis and
now getting chemo. The doctor doesn't want to use heparin and wants
the nurses to use sodium citrate. I have found much information this
practice, but thanks to the few that did respond. One of the responses
included using CLC for the cap to avoid heparin.
Anyone else have experience with this that you could lead me in the
right direction for more information? Sorry to ask again, but thought
if I clarified the type of catheter there might be more responses.
I am being asked to create a policy and procedure for this. I am
resistant to do that for 1 patient (I know there might be someone else
at some time). Currently, I am recommending the doctor write the
order for the substitution of sodium citrate dose/volume/etc., instead
of creating a policy. Am I wrong? I need some feedback about
thinking that writing a policy won't cure this problem. It is a
medical order, not a policy. Right?
Gwen
