Our facility is in the process of drafting a protocol for the use of sodium citrate as a final flush in patients with HIT. I've been unable to find much information on the volume that should be used for this purpose; the majority of the information deals with dialysis lines and using a flush volume based on the catheter volume itself. In all the dialysis lines I've seen, this volume is printed on the catheter itself, making this process relatively similar. Any suggestions? Thank you, Nancy Morris, RN
The national standards have established twice the internal volume of the VAD as the locking volume for heparin. I would follow the same guideline unless the lock solution has some restriction on total amount that enters the bloodstream. For 4% sodium citrate, this should not be a problem, however larger concentrations of citrate would be a significant issue. The internal volume of the catheter + any add-on devices such as extension sets and needleless connectors must be added, then use that much or up to twice that volume. This would be different for PICCs vs an implanted port. 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
Thank you for your response. Any tips on finding the volumes of the ports themselves? I've looked at the packaging, the patient cards and radiology notes for at least the length (to use in the equation from Bard) and am coming up with nothing. The extension does list a volume of 0.3 ml.
Nancy
This information is always found in the instructions for use booklet that comes in the package of every VAD of all types. These booklets are found as soon as the package is opened and most often get tossed in the trash. Many companys also post these IFUs on their websites. 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
Nan,
You didn't say which device (brand/manufacturer) you wanted this info for. If you google "Bard Access port priming volumes," the 1st entry is Nursing Guide for Bard powerports. On pg 10, there is a chart which lists the priming volume per cm of the different French sizes and materials (about 0.02ml/cm). Also there is a chart with the port body priming volumes (0.5-0.6mls) on the same page.
If you google "Smartport priming volumes," the first entry is guidelines for healthcare providers from Angiodynamics and it also has a chart with the priming volumes. (I do not work for either company.) So it would seem that there is some information on brands/devices available with some diligent searching. The sales rep also would have the information.
I suspect the reason that vendors put the priming vol in ml/cm is that port catheters may be trimmed to fit the patient, although I have never seen this piece of information (how many cms were trimmed) in any medical record related to port implantation. Email me if you have trouble finding what you're looking for: [email protected]