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Elisa Scher
Central Venous Catheters

Wondering if anyone out there has any policies to address how to care for portacaths and hickman lines with patients that present with heparin induced thrombocytopenia.  Trying to find alternatives to flushing with heparin.
Thank you.


Daphne Broadhurst
How about a positive or

How about a positive or neutral-displacement valve & therefore just a saline lock? Or have you considered using 4% Sodium Citrate, which is what our facility is now using to lock our dialysis lines routinely, thus eliminating Heparin? There's no published literature looking at Na Citrate in non-Hemodialysis lines. Several articles studying citrate in the hemodialysis population have been recently published, as listed below.
Daphne Broadhurst
Ottawa Canada

Grudzinki L et al. Sodium citrate 4% locking solution for central venous dialysis catheters—an effective, more cost-efficient alternative to heparin. Nephrol Dial Transplant (2007) 22: 471–476(Conclusions:”The pharmaco-economic benefits of sodium citrate 4% are well supported by this analysis. Furthermore, citrate offers several clinical advantages over concentrated heparin: citrate lock avoids heparin-associated bleeding complications, improves reliability of INR assays and provides an effective alternative for patients with suspected or confirmed heparin-induced thrombocytopenia.”) Lok C et al. Trisodium citrate 4%—an alternative to heparin capping of haemodialysis catheters. Nephrol Dial Transplant (2007) 22: 477–483(Conclusion: Citrate 4% has equivalent or better outcomes with regards to catheter exchange, TPA use and access-related hospitalizations compared with heparin locking. It is a safe and less expensive alternative.”)


Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

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