What dose of Heparin does your centre use to cap CVC lumens post-HD?
At the Scarborough Health Network, we use Heparin 5000 units to 10,000 units per port to cap lines for patients who cannot use Sodium Citrate.
We have been stocking Heparin 5000 units/0.5 mL vials on the unit (to comply with Accreditation Canada standards), but now these vials are on backorder with NO release date.
Does your centre have any experience in using smaller doses of Heparin to cap lines, and did you encounter any major issues?
Heparin 1,000 u/mL is what we use for locking almost all our HD patients in Manitoba. We have never switched to 4% citrate as more costly than 1,000 u/mL heparin.
This meta-analysis recommended low dose heparin for HD locks: https://www.ncbi.nlm.nih.gov/pubmed/27191662
This position paper states that heparin 1000 U/ml, or 4% sodium citrate are suitable choices for lock solution in HD: https://www.ncbi.nlm.nih.gov/pubmed/18764795
Lavern Vercaigne did our own (unpublished) study that was presented as a CSN poster years ago with the conclusion that: There were no statistically significant differences in alteplase use or catheter-related infections between the heparin 1,000 u/mL and 4% citrate groups.
Lori Wazny, PharmD.
MB Renal Program
Thanks for the info Lori!
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