I have a question regarding the use of tunneled dialysis
catheters. We have started using the MedComp double lumen tunneled dialysis
catheters in our pediatric patients with neuroblastoma and medullablastoma.
These catheters are placed with the dual purpose of general central access
and apheresis of stem cells. Because this is a new way to use these lines,
it is considered an "off use" of these lines and there are no flushing
guidelines. Our patients do not have other IV access, only this double lumen
tunneled dialysis catheter that is used for everything - blood product
administration, blood draws, IV medication administration, fluid/TPN
administration, and apheresis (stem cell harvest done over 1-2 days). The
apheresis purpose is minimal and a majority of the time, this line is used
in place of a broviac central line. With this, we are heplocking these lines
with 10unit/mL of heparin, like we do with the Broviac lines. Do any of
you have experience with these lines? If so, here are my questions:1. Do your patients also have other central/IV access?
2. What are your flushing guidelines? Do you have different flushing
guidelines surrounding the apheresis procedure versus the times when the
line is used as a central line? What about flushing guidelines for discharging
to home?
3. What issues have you had with these lines, if any? (clotting, infection)
Thank you,
Kristi Selck
We use Bard's version of these catheters for our ASCT and Sipuleucil patients because of the dual benefit (like you) of apheresis and routine infusion. They are large bore, high flow catheters and as such, per INS Practice Standards (45.P), require flushing and locking protocols similar to hemodialysis catheters. Therefore, we lock these catheters with heparin 1000units/ml and we flush each lumen and lock each lumen with a volume of 1000units/ml heparin that is equal to the volume of each lumen. In the past we tried to get away with lower concentrations of heparin out of fear that clinicians would accidentally flush prior to aspirating the residual heparin, but inevitably we had occluded lumens. We do these maintenance flush/locks MWF, with weekly dressing changes (we don't stop applying dressings, though Standards indicate that consideration may be given to not using dressings in non-immunocompromised patients once the site has healed). We will even consider teaching a capable family member how to do these flushes at home to save the patient visits to our clinic, but this is on a case-by-case basis. I'd love feedback if anyone objects to these practices!
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA