Catheter lock solutions

This is sort of a poll--What are you HD nurses using to lock your patients' catheters after treatment? Heparin? If so,what concentration?

Any one using anything else,like Citrate,TPA or the mysterious 'blue solution' in the clinical trials?

Thanks for the input.

We use heparin 1:1000. I've used citrate only on a pt. that was allergic to heparin.

We use 1:5000 and dilute with saline to the amount of the cath lines. Ie: 1.7/1.8 cc usually marked on each port. We dont have much issue with clotted caths but do with poor placement sometimes.

In my practice, i have found a 1/1000 solution of heparin undiluted@ 2.5 to 3 cc reguardless of fill volumes will flush the cath and reduce the risk for cath failure r/t clotting

Dave

We used to use 1/5000...and then we switched to the 1/1000. We seem to be having quite an issue with caths not working as well...any suggestions?!

RN2B..when you say they don't work well,do you mean they are clotting off completely or that you just aren't getting good flow rates? Have you tried a TPA dwell to remove the fibrin build-ups?

My original question was inspired by my facility's reaction to this year's heparin scares/shortages. The initial knee-jerk reaction was to say no heparin in any line. Period. Just use saline for everything. That included PICC's,ports,all CVC's and HD cath's. Our HD people,wisely, started using Citrate 4% and that's what we in the ICU's used for our CRRT patients. So 2 weeks ago,when I took a pt. off CRRT,I locked the line with Citrate. A few rooms down,a different nurse used Heparin after his machine crashed (we can use Heparin again according to the powers that be). Then a different pt. received HD by the HD staff and her line was locked with TPA since she's had some occlusion problems in the recent past.

I was hoping to hear from someone involved in the trials for some of the new solutions,like Taurolidine,high-dose Citrate (40%) or the methyline blue/citrate combination.