I'm wondering what other institutions are doing when instilling Hepain into hemodialysis catheters. I've read literature that says to instill the amount equal to the fill volume of the catheter and others that say to add 0.1ml to that fill volume amount. What does your institution do? It doesn't look like INS gives a volume recommendation that I can see.
Thanks!!
INS SOP states internal volume plus 20%. This to ensure the solution reaches the entire catheter length but limit the overspill.
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
Lynn,
I do read in the INS SOP 40 Flushing and Locking section I-5 where it refers to locking CVADs with lock solution to "equal the internal volume of the VAD and add-on devices plus 20%". Yet Section J. states "Lock hemodialysis CVADs with heparin lock solution 1000units/ml, 4% citrate, or antimicrobial lock solutions" . It seems to me the SOP is differentiating between locking a CVAD and a hemodialysis VAD and when referring to the hemodialysis VAD there is no mention of the 20% overfill. Am I reading this correctly? If we were to overfill a tunelled hemodialysis catheter that had a fill-volume of 2.7 ml per lumen that could be a significant amount of heparin (over 1000units).
Thanks for your help with this.
Wendy Douglas BS, RN VA-BC
Hemodialysis catheters are considered to be a type of CVAD. 20% overfill is derived from HD catheters, see references in SOP. So 20% would apply to HD catheters. Some facilities may still use heparin 5000 units per mL. Overspill is needed to ensure the entire lumen is locked. Large doses can lead to alteration of coag values, but 1000 units per mL is not really considered to be high dose heparin lock for HD catheters.
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