When using Sodium citrate as a lock solution in an unused PICC lumen (D/T heparin issues), how often do you flush with this solution? How long can it dwell? I am seeing that there is a need to withdraw and discard the Na citrate prior to using the lumen. If we flush the lumen every 12 hours which is what we would do if we were using Heparin, could the withdrawal of the solution (along with blood) increase the risk of clotting? Allowing it to dwell longer than every 12 hours would be ideal. Thoughts?
What concentration of sodium citrate are you using? The larger concentrations (around 47%) should be withdrawn, however the smaller concentrations of 4% do not have to be withdrawn. I think you can use this just as you would a heparin lock solution. Our Canadian colleagues now have a prefilled syringe with 30% ethanol and 4% citrate. Maybe they can share their experiences with this lock solution. Most of this work has been done in Europe. Last year at WoCoVA, I learned that they consider all "locking solutions" to require withdrawal. I do not believe that we could or should try to do that here in the USA. I think an alternative locking solution must be acceptable for injection into the patient, just like we now do with low doses of heparin. I think it would be a nightmare to try to change nursing practice to aspirate this lock solution out of the catheter. 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
The nurses would only do it once and never forget, the sensation is amazing, awesome and downright nasty. I am using the 46.7%, for personal use, as no other strength available in this country.. and if I have to go near a hospital at all, then I have it well labelled that to flush would be fatal. [0.3ml is enough to have me on my knees]
What are they doing for catheters that cannot have alcohol?? and the patient no heparin?
As far as I know only dialysis units are using it at that strength, even in Europe, and I believe[ but not positive ] that all lines are aspirated on access, so for them it would be natural to withdraw.
Sounds like you have a dialysis catheter. You may want to see if you can get in on one of the locking trials for the kinelytic (urikonaise deriviative), tenectaplase (TPA derivative), ethanol. Locking of ports with saline only is in a research protocol as well. Short term acutes and PICC's are often locked with saline only at this point if a patient is heparin sensitive. You can also use a valved catheter for saline only except for dialysis. Dialysis is more apt to pull out a locking agent however, mistakes can happen.
kathy
Kathy , thanks for your suggestions but,
I am not in the USA, so limited to trials and access meds, and certainly not any tPA. type.. and I am not a dialysis patient tho I have both Port access and AV [not being used except in emergencies at present] valved caths also not available for adults. Dont think 12yrs of PN is short term use, and I wanted that extra antibacterial cover for that reason.
After reading what Lyn feels about saline only, and the stats not showing good results, and with my ability to clot off anything I am not happy to go saline alone. I just make sure no nurse or doc come near me, having been one for over 30yrs and seen so much lack of care to detail, more as a patient, but also as a co worker!
Kathy , thanks for your suggestions but,
I am not in the USA, so limited to trials and access meds, and certainly not any tPA. type.. and I am not a dialysis patient tho I have both Port access and AV [not being used except in emergencies at present] valved caths also not available for adults. Dont think 12yrs of PN is short term use, and I wanted that extra antibacterial cover for that reason.
After reading what Lyn feels about saline only, and the stats not showing good results, and with my ability to clot off anything I am not happy to go saline alone. I just make sure no nurse or doc come near me, having been one for over 30yrs and seen so much lack of care to detail, more as a patient, but also as a co worker!
Hope all goes well with you. Sorry to hear about the bad care
In the U.S. we have adult valved ports and tunneled catheters from several manufacturers. It is interesting to hear that this is not available worldwide for patients that have issues with heparin. It is a shame that not all thrombolytics are also available worldwide. I was aware that CathFlo is not offered in all countries for catheter clearance.
Keep a watch out on your lines and I wish you good health
Kathy Kokotis
Bard Access Systems
Thanks, Lynn - I agree completely. We are using a 4% solution. I will instruct the nurses to use it just like Heparin in dose size, frequency, etc.
Wendy Erickson RN
Eau Claire WI
I believe Lynn may have wanted to add the fact that sodium citrate for locking was turned down by the FDA for market approval last year. I would hestitate to use this locking solution as a RN without a MD/pharmacist approval . I would never infuse this into the patient as obviously is not approved in the United States as a safe locking solution by the FDA. This locking discussion should be coordinated with youir pharmacist who is well versed on drugs and labeling. If you are in Canada however it is an approved locking solution.
Kathy Kokotis RN BS MBA
Bard Access Systems
Kathy, you will have to be more specific about what concentration was rejected by the FDA. To my knowledge, no company has been able to meet the high level of requirements set forth by the FDA for any of these solutions. So I did not think that any company had even been able to submit an application for any of these combo device/drug products. 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
There is no concentration market approved for use by the FDA at this time for sodium ciitrate as a cathetet lock or flush. As mentioned at the national AVA 2010 by (Sheertz, Mermel, Berenholtz) several locking solutions have been submitted for approval but none have been approved to date. This may change but at this time a locking solution other than heparin has not made it thru for labeling regardless of the compostion or concentration.
Kathy Kokotis RN BS MBA
Bard Access Systems
There is no concentration market approved for use by the FDA at this time for sodium ciitrate as a cathetet lock or flush. As mentioned at the national AVA 2010 by (Sheertz, Mermel, Berenholtz) several locking solutions have been submitted for approval but none have been approved to date. This may change but at this time a locking solution other than heparin has not made it thru for labeling regardless of the compostion or concentration.
Kathy Kokotis RN BS MBA
Bard Access Systems