Colleagues,

Today I was ask to help with some education for a patient who just had a Port placed.

In reviewing his chart the first thing I noted was that he was allergic to heparin.  When reviewing this with the pt he was 

unable to tell me what happens when he received heparin.  He related a story about being in the hospital

and after receiving heparin, it made him bleed too much so his doctor told him "he was allergic to heparin".

Unfortunatley his medical records are in another state and will take some time to obtain.  I have packed him for now with

Cathflo.  I am wondering what you have experienced with heparin allergies.  Are you able to switch to "pork" heparin vs

"beef" heparin or vice versa?  If he really has HIT what do you pack Ports with, and how much, how often...

Need your help.   Thanks in advance. 

 

 Very good question. I would

 Very good question. I would not trust saline alone to keep an implanted port patent for a month. There are no other options on the US market in a prefilled syringe. Citrate is probably the best option. You might be able to obtain it in a vial, but I know it is available in a bag as IV fluids. 4% sodium citrate from Baxter. I know opening a whole bag for one flush monthly might be costly though. I guess that is better than a clotted lumen. I would check with your pharmacy to see if it is available in a smaller sized vial. In Canada, they have access to a prefilled syringe with 4% citrate and 30% ethanol that is working well for many facilities. There are several studies supporting this, along with other alternative solutions. But citrate may be the easiest to obtain. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

port flushing protocol with heparin allergy

We have a resident with an implanted port and a heparin allergy.  the port is currently non-accessed, so that means a monthly flush.  since it is non-vlaved, we would flush with 5cc NS and 5cc 100U/ml heparin.  Since the port is not accessed but monthly, what do you recommend for monthly flushes?

Thanks Ladies for the

Thanks Ladies for the info. 

 I didn't make myself real clear.  I do understand HIT is about clotting and not bleeding.  I have heard Residents tell pts when they have HIT to just tell other health car professionals when asked about their allergies that they are allergic to heparin because they should never receive it.   So if this patient has been told to tell us he is "allergic" to heparin maybe the real issue is not a allergy.  We really don't want to find out. 

Thanks again for your help.

M Galloway, RN, BSN, VA-BC, CRNI

That is correct - many

That is correct - many companies are working on alternative solutions for flushing and locking catheters but there are none that are commercially available in the US yet. Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Submitted by Daphne

Margy, Sodium Citrate 4% is another alternative to heparin as a catheter lock solution. Our tertiarty care medical center has now converted from the use of heparin to sodium citrate as our protocol lock solution for dialysis catheters. Concern over re heparin-related skewed coagulation lab results was the primary driver for the conversion. Published literature (see below) demonstrates 4% Sodium Citrate's safety & efficacy. As Lynn didn't mention this solution in her post, I assume it may not yet be commercially available in the US

References:

Grudzinski L et al. Sodium citrate 4% locking solution for central venous dialysis catheters—an effective, more cost-efficient alternative to heparin. Nephrol Dial 2006; 22:471-476
Lok C et al. Trisodium citrate 4%—an alternative to heparin capping of haemodialysis catheters. Nephrol Dial Transplant 2007;22: 477-483  

 

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

With HIT, the problem is

With HIT, the problem is clotting, not bleeding. But you have to error on the side of patient safety. There are 2 reports that I have discussed on my blog, one using alteplase and one using lepirudin as an alternative to heparin for catheter locking. Go to http://hadawayassociates.blogspot.com/2007/12/alternatives-to-heparin-lock-solution.html to read the blog entry on this issue. Lynn

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861