bicarb to declot lines

[RNmom08]

I have heard that using bicarb is a way that one of our docs prefer to declot central lines. Can anyone tell me or direct me to some articles about this and the safety of using this? Our hospital has no policy on using bicarb for this.

[BinkieRN, BSN, RN]

Sodium bicarbonate is used to declot central lines. The doctor will have to write

an order to declot using specifically Sod Bicarb.

First verify the occlusion by attempting to aspirate or instill NS.

Draw up 1 ml Sod Bicarb and instill it into the hub and let it remain in the line for

2-5 minutes. Then attempt to aspirate. If successful pull back 5cc of blood to

throw away. Flush the line with 5cc NS and resume IV therapy

[nrsang97, BSN, RN]

I can see how it would declot a line, but I have never seen it used. Interesting. We have a protocol for TPA.

[RNmom08]

BinkieRN: Have you found that it works better or about the same as t-PA?

[miggy_16]

...nice info...yet, the protocol in our institution is to have it run in a separate iv line...we have t-pa's instead...

[dauschundlover]

A good source regarding this issue is the INS, Intravenous Nurse Society. I believe u use bicarb for certain clotting factors but not necessarily blood. But check with INS.

[BinkieRN, BSN, RN]

BinkieRN: Have you found that it works better or about the same as t-PA?

I couldn't compare as I haven't used t-PA yet. We use Bicarb first and so far no problems, it works just fine. I'm not checked off yet to use t-PA.

Why bring out the army if a soilder will do the same job?

[BinkieRN, BSN, RN]

...nice info...yet, the protocol in our institution is to have it run in a separate iv line...we have t-pa's instead...

i'm not talking about a bicarb infusion....that's a whole different subject all together. the op asked about declotting a cl

[Pedi-Gree, BSN, RN]

t-PA will only unclog a line if a blood clot is the culprit. If the clog is caused by precipitated drugs, the pH of said drugs will dictate whether NaHCO3 is going to work or if you'll need to use HCl. The few times I've had to use HCl the line declogged and had blood return about half the time. The other times there was no blood return but the line was flushable. Rather than flush a lumen full of acid into a peds patient, we run a saline infusion at 1 mL/hr through that lumen for six hours to minimize the acid-base imbalance.

[iluvivt, BSN, RN]

Sodium Bicarb can only be used to clear an occlusion that is caused by a precipitate. It is sometimes used to clear an occlusion caused by a medication soluable in a basic state. Dilantin is an example with a ph of 12. It is not FDA approved and therefore is an off-label use. The majority of occlusions are caused by blood or fibrin build-up. Tpa is still your best bet unless you can very certain it is caused by a precipitate. Tpa will not work on any drug precipitation. I have tried this for a few confirmed Dilantin precipitates and was not impressed. We always have to re-site or exchange these CVCs. Also if you have an IV team they can assist you in narrowing down a problem and point you in a good direction. If not sure what is causing the occlusion and you have ruled out the obvious things it can not hurt to try the Tpa before proceeding with more advanced options. Hope this helps. Mary