In the process of reviewing our institution's policy on exchanging the Heparin lock solution in apheresis/hemodialysis catheters I was looking at the 2016 INS recommendations. I see that the Heparin lock solution for the apheresis catheter & the hemodialysis catheter is different. Heparin lock solution 1000u/ml for dialysis catheters & Heparin 100u/ml for apheresis catheters. The IFU's for the current catheters we use recommend the 1000u/ml Heparin. We use the same catheters for apheresis as we do hemodialysis. Does anyone know why the difference in the solution? Also our institutional policy for the exchange is every 3 days (or 2x week) if these catheters are not in use. I can't find the recommendations on the frequency of these exchanges. Input on this would be appreciated as well.
Those recommendations are evidence-based for the heparin recommendations along with all the other solutions listed. See the references listed for each of those statements. Usually an apheresis catheter is not the same as a hemodialysis catheter. An apheresis catheter is usually a little smaller and is not required to have the high rate of flow as an HD catheter. The amount of heparin used should be as low as possible Even with the lowest amount, HITTS can still develop as it is not dose-dependent. By "exchanges", I am assuming you mean aspriation and flushning and instillation of the next locking solution. You would only need to do this with the 1000 unit per mL. Smaller doses of heparin can be flushed through the lumen into the bloodstream. Antimicrobial lock solution should be aspriated also. There is no recommendation for the frequency of doing this flush and lock procedure. it is done after each use of the VAD. If there are no HD or pheresis procedures, the VAD should be removed. See standard on VAD removal Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861