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Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

  • 1.  Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 9 days ago
    ​​Dear everyone,

    I JUST WONDER YOU CAN HELP ME WITH THIS CLINICAL QUESTION ASKED BY ONE OF THE INSTRUCTOR FORM THE ICU.

    Patient admitted in the ICU for the medical oncology management, the second week of treatment doctor ordered to de access the port A Cath with 500 unit of heparin  instillation.  At the same time patient is  diagnosed with heparin induced thrombocytopenia, Will you go head with the heparin instillation while deaccessing the port  or hold it because of the patient diagnosis with heparin induced thrombocytopenia. Please share your clinical decision making in this special  situation as well as any best practice guideline using in your hospital.

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    Namitha SIVANKUTTY
    Clinical Instructor
    King Faisal Specialist Hospital
    Riyadh Saudi Arabia
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  • 2.  RE: Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 9 days ago
    There is now ample evidence to support the use of saline-only for CVC maintenance--including implanted ports. (We finally changed over 3 months ago and have not seen any statistical change in tPA use.) For someone with HIT, heparin is avoided. If the physician ws still uncomfortable with NS (many are not experts in vascular access maintenance), then sodium citrate has been used successfully, and does not have the same side-effect issues of heparin.

    Seth

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    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
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  • 3.  RE: Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 6 days ago
    Thank you seth for your reply. ​

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    Namitha Sivankutty
    King Faisal Specialist Hospital
    Kottayam
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  • 4.  RE: Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 8 days ago
    We began piloting the use of NS (push-pause with 10ml) instead of heparinized saline in our cancer center back in February of this year. So far what we have seen mirrors the data from elsewhere in the country, and we have had no increase in the need for tPa. Patients can sometimes take a little reassuring, but once the evidence is explained to them, they are usually fairly understanding. I personally wouldn't use heparin on a patient diagnosed with HIT, and I'd speak with the physician about that particular order.

    Thanks!

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    Jessica Smith, BSN, RN, CCRN-Alumnus
    Registered Nurse-Outpatient Infusion
    Vanderbilt Ingram Cancer Center
    Nashville, TN
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  • 5.  RE: Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 6 days ago
    Thank you Jessica. ​

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    Namitha Sivankutty
    King Faisal Specialist Hospital
    Kottayam
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  • 6.  RE: Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 8 days ago
     Hope this helps.

    Hidden Heparins: HIT Happens

    Administration of heparin in quantities as small as those routinely used to flush central venous catheters and other vascular access devices can lead to HIT antibody formation or HIT itself (12–14), and minor exposure via this route in a patient with persistently circulating HIT antibodies can promote re-emergence or worsening of thrombocytopenia or thrombosis.(15)



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    Lori Sammartino, MSN, OCN, NP-C
    Oncology Nurse Manager
    Hackensack Merdian Health/JFK
    Edison, NJ
    Lori.Sammartino@hackensackmeridian.org
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  • 7.  RE: Port A CATH DEACCESSING WITH HEPARIN INSTILLATION

    Posted 6 days ago
    ​Thank you Lori

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    Namitha Sivankutty
    King Faisal Specialist Hospital
    Kottayam
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