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Carole Rumsey
Sodium Citrate

I work in the home infusion world and I have a question:  if a patient is allergic to heparin, and saline flush only does not keep the CVAD open and we are having to use Cathflo often to resolute the partial occlusion, what is the next step?  Has anyone used sodium citrate as the CVAD locking soluction in the home care setting?  If so, would you be willing to share your policies and procedures?  We are currently using positive displacement needleless connector.

Thanks so much for your thoughts on this.

Carole Rumsey, RN, CRNI

Home Infusion Program Manager

Sutte Care at Home

DuralockC is what I use for

DuralockC is what I use for my port, placed back 2009. I made sure the surgeon measured the cath and the volume was then exact! 1.6ml plus 0.3 for the  ppCap.  I am not in the USA, but do know that  Sod Citrate is being trialled by dialysis units. Theirs is a different  %,  mine is the 46.7% which can be fatal if mistakes are made and 10ml inj as flush. causes low calcium and cardiac arrest.

In my case I have refused anyone else giving it after the very first dose by the surgeon as the effect is instant.. dizziness, tingling, ectopics and pain with 0.2ml more than needed.

I do not know if my hospital has a policy, I have worked my own out, but know they are now using it for their dialysis patients.

 The package insert states no longer than  4 days and needs changing, but I find that it will lock and keep open for 3-4wks, Insert is of course aimed for those who would be having dialysis again.

The biggest and most dangerous problem would be, that along comes  a health provider and just flushes, instead of seeing that it is fully withdrawn. IF it cant be withdrawn then it needs to be slowly flushed over 30min, to prevent side effects.

Lyn has  mentioned before that she thinks it would be too risky to be used. I dont know how 'dangerous' the Taurolidine is which is available in Europe and the UK.

all of course, not  passed by your FDA!

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