We have been asked by the Nephrologist to start flushing PICCs and  triple lumens with Citrate. I am not familiar with Citrate. How much? How ofter? Our response is "to just flush with NS if the patient can not receive Heparin." However, the doctor has asked us to develop a policy and procedure for flushing catheters with Citrate. Please help! Thanks so much.
Some published benefits of Citrate:
Grudinski's study concluded "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" and Lok demonstrated that "Citrate 4% has equivalent or better outcomes with regards to catheter exchange, TPA use and access-related hospitalizations compared with heparin locking."
Regards,
Daphne Broadhurst,
Ottawa, Canada
References:
1. 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
2. Lok C et al. Trisodium citrate 4%—an alternative to heparin capping of haemodialysis catheters. Nephrol Dial Transplant (2007) 22: 477–483
3. Pepper RJ et al. Inadvertent postdialysis anticoagulation due to heparin line locks. Hemodial Int. 2007 Oct;11(4):430-4.
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada