Normal saline rinses: yes or no

worldnurse · Mar 10, 2006

I often wonder the same thing when my patients clot away in spite of painstaking flush after flush.

Here's a link to a sience article that confirms it doesn't seem to work very well for stable patients at least.

http://ndt.oxfordjournals.org/cgi/content/abstract/21/2/444

diabo, RN · Mar 11, 2006

We use Citrasate for the acid portion when heparin is contraindicated. Works quite well and does not raise the calcium level in the patient. Some boluses may still necessary in some instances. The NS is not for visualization purposes. It's used to help prevent cloting. 100 cc's at a time won't allow you to see a clot in the venous chamber where they usually hang out. Sometimes we use a small amount of heparin along with the citrasate Like 500/500

Steve

AraratRN · Mar 17, 2006

When I was first trained, I was told that NS was used as flush to PREVENT clotting as was stated, the I spoke to nurses that have been doing dialysis 'forever' and was told that NS does NOT prevent clotting,it only allows you to see that it is or is not clotted. How would NS prevent clotting? Thanks for your responses, it is confusing to try and get to the best practice..

NephroBSN, BSN, RN · Mar 17, 2006

When I was first trained, I was told that NS was used as flush to PREVENT clotting as was stated, the I spoke to nurses that have been doing dialysis 'forever' and was told that NS does NOT prevent clotting,it only allows you to see that it is or is not clotted. How would NS prevent clotting? Thanks for your responses, it is confusing to try and get to the best practice..

If NS 100 cc is given every hour it can help slow clotting. Depends on the patient. Many patients run 4 hours heparin free and have hardly any clots in the system some can't get through two hours.

It's a preventive measure.

newfienurse · Mar 17, 2006

In the acute unit I'm currently working in we hardly ever use Heparin. Most of the other nurses don't do NS flushes and have problems with systems clotting or the TMP. I generally give 100ml flush every 1/2 hr and just count it in the pt's goal at the beginning, especially if they have a high platelet count. I rarely have a problem which is great because I absolutely hate restringing a machine during a tx. Prevention is the best option.

NephroBSN, BSN, RN · Mar 17, 2006

In the acute unit I'm currently working in we hardly ever use Heparin. Most of the other nurses don't do NS flushes and have problems with systems clotting or the TMP. I generally give 100ml flush every 1/2 hr and just count it in the pt's goal at the beginning, especially if they have a high platelet count. I rarely have a problem which is great because I absolutely hate restringing a machine during a tx. Prevention is the best option.

IF and that's a big IF you can run the blood pump at 400 or greater you might be able to get away with 100 cc's every hour.

AmyLiz · Mar 18, 2006

If NS 100 cc is given every hour it can help slow clotting. Depends on the patient. Many patients run 4 hours heparin free and have hardly any clots in the system some can't get through two hours.
It's a preventive measure.

That's what our unit does. Some folks get flushes q1/2h who seem to clot faster.

We have one pt though...he's a case. He's on oodles of heparin, gets flushes and still clots off his line qtx. He hasn't run a full tx in 2 wks. It's terrible. We're considering trying to put some NS on a pump and run it into the venous chamber, since that's the one place where he seems to clot most. We've got to figure something out for the poor guy!

worldnurse · Mar 19, 2006

That's what our unit does. Some folks get flushes q1/2h who seem to clot faster.
We have one pt though...he's a case. He's on oodles of heparin, gets flushes and still clots off his line qtx. He hasn't run a full tx in 2 wks. It's terrible. We're considering trying to put some NS on a pump and run it into the venous chamber, since that's the one place where he seems to clot most. We've got to figure something out for the poor guy!

I have a patient who was put on Coumadin because she clotted her graft so much between treatments. I have never heard of this being done for patients who clot during treatments, but unless it's contraindicated it might be something to at the very least suggest since Coumadin works on a different part of the clotting chain and it sure sounds like you patient has some hematological issues. Are his labs normal?

NephroBSN, BSN, RN · Mar 19, 2006

I have a patient who was put on Coumadin because she clotted her graft so much between treatments. I have never heard of this being done for patients who clot during treatments, but unless it's contraindicated it might be something to at the very least suggest since Coumadin works on a different part of the clotting chain and it sure sounds like you patient has some hematological issues. Are his labs normal?

Have your tried heparinizing your dialyzer?????

OPPs wrong poster... I'll go away now....

NephroBSN, BSN, RN · Mar 19, 2006

That's what our unit does. Some folks get flushes q1/2h who seem to clot faster.
We have one pt though...he's a case. He's on oodles of heparin, gets flushes and still clots off his line qtx. He hasn't run a full tx in 2 wks. It's terrible. We're considering trying to put some NS on a pump and run it into the venous chamber, since that's the one place where he seems to clot most. We've got to figure something out for the poor guy!

Have you tried heparinizing the dialysizer??????

AmyLiz · Mar 21, 2006

We've tried everything that we can do without a doc's order. Today the doc came around and lowered his Epo dose, since his Hgb was extremely high. Doc said hopefully that would help some...although I have my doubts as to how much that will help. Today the pt clotted off his line yet again. It's been just over 2 weeks since he had a full tx, so we're all extremely concerned. We're going to try a continual saline drip into the venous chamber on Wednesday. Hopefully that will help solve some of the clotting issues.