CRRT: Flushing Access Ports - How do you do it?

[Cowboyardee]

Hi all.

I've used the prismaflex crrt machine for a number of years. Of course, on crrt you'll often have issues where the access pressures abruptly become extremely negative, or in other words, the patient's dialysis port temporarily occludes. Might be a clotting issue, might be a kinking issue, and often it seems to just be collapse of the vessel the dialysis catheter is situated in, the port sucking onto the vessel wall, etc.

Long term, there are plenty of solutions to this problem, but I'm not asking about those. I want to know about the first step you do to unclog a temporarily clogged port. 

With the prismaflex, it seems we clamp the access line and catheter, disconnect the two, flush the catheter with a saline flush, reattach it to the access line, and restart therapy. Does that sound like what you do in your ICUs? Anyone have a different strategy? 

If it seems like I'm asking for people to spell out a very simple, obvious procedure... I am. Disconnect, flush, and reconnect, right?

Beyond that, I havent used other crrt machines. I'm aware that the NxStage is popular as well. I've heard that we use the same process for that machine. Disconnect, flush, reconnect, restart. Right?

Do any CRRT machines have internal flushing built into them? Are any hospitals routinely rigging up flushing systems (e.g. a stopcock and a saline bag) to their access ports to avoid disconnecting and reconnecting? Have you seen or used some other strategy that I haven't heard of?

 

[Cowboyardee]

By the way, are any crrt machines besides the Prismaflex and the NxStage currently popular or used much at all in the US, and do they have a built-in flushing mechanism?

[R5RN, BSN, RN, EMT-P]

When I was in the ICU, we also used Prismaflex and we used the same method you are describing. Disconnect, flush, reconnect (cleaning the patient's access port with isopropyl alcohol in between). We did not have any built in method of flushing or create our own setup to prevent disconnecting.

I do not know about other CRRT machines besides the Prismaflex, and I only worked ICU at one hospital.

Hope that helps!

[R5RN, BSN, RN, EMT-P]

Also to clarify (because IDK if you want it this specific), but I pull back first to see if I have blood return before flushing.

If nothing is working, we would also switch our access and return lines.