Wednesday, February 8, 2017

The Secret Weapon To No Heparin

The title of this post might provoke a chuckle (or two), but when on the subject of central lines, Heparin is an inevitable topic. 

Heparin is a blood thinner. It is "an anticoagulant that prevents the formation of blood clots." [ x ]  It is used universally in patients with central lines to inhibit the catheter from clotting off from blood clots. 

Read Types of Central Line Access

Per line care directions, home infusions companies provide pre-filled syringes filled with Heparin. Patients are directed to flush with their central line after its use with saline prior to clamping the catheter. This is is often termed as "Heparin locking" or a "Hep-lock." The amount of Heparin the line is locked with is dependent on the length of time the central line is going unused. Following this protocol ensures the patient does not develop blood clots in the line or elsewhere in the body. 

However, there are unique circumstances that prevent Heparin use. Mine is one of them! As I am a moderator of the Facebook group, IV Therapies For Mast Cell Disease + Related Conditions, I get asked about my experience with Heparin quite frequently. 

Heparin Toxicity

During the admission I received my first PICC line, I was over dosed on Heparin by an out-of-state hospital. You see, I should have never been given Heparin with my symptom presentation.
Heparin, while being a blood thinner, is also a mediator released by mast cells upon degranulation. [ x
Because of Mast Cell Disease, the mast cells in my body excessively releases specific mediators. Heparin is one of them.

My body is also more prone to bleeding and fragility because of Ehlers Danlos Syndrome. Despite these factors, I was receiving Heparin injected into my TPN (Total Parenteral Nutrition) and numerous 100 unit Heparin flushes daily. That, combined with what my cells were overreleasing, was too much. 

Over time, the high dosing resulted in a drop in platelets, nose bleeds, bleeding from little trauma, and bruising. The pain was horrendous after returning to my home state, with the home health nurse mentioning that even my muscles were hemorrhaging as I was sent straight to see the intensivist at the hospital.  

Aside from the toxicity incident, the Heparin flushes had the tendency to cause Mast Cell Reactions. The doctors assumed it would be the same for Lovenox or other blood thinners.

Once I had to have a more permanent line placed, the decision about the type of line needed was based on this need to avoid Heparin. In a case like mine with no history of blood clotting problems, there are safe methods of locking the line to avoid it clotting off without resorting to hep-locks! 

Line Type

Certain brands of central lines or lines with special catheter tips do not require Heparin. 

A groshong is a type of tunneled line that requires saline online locks ONLY without a clamp.
  • Bard Power Port
If long, tunneled lines are not your preference, Bard has the option of a Power Port with Groshong tip catheter.
  • Bard Power PICC
Non Power PICC lines and regular Hickman and/or Broviac tunneled lines are more common. They do not have a groshong tip. Heparin is normally required.
  • Bard Power Hickman
The Power Hickman is meant to be flushed with Heparin. However, saline locks are suitable for those frequently accessing their line.

"For frequently accessed catheters (accessed at least every 8 hours), flushing with 5 ml of normal saline without heparin between infusions has been found to be effective." [ x ]

For the previous two years, the Bard Power Hickman is the option I chose to avoid using Heparin. I have followed the directions from the manual of flushing it per every 8 hours. It has yet to ever clot off, even infusing TPN (Total Parenteral Nutrition) with a thick, sticky lipid solution. 

I hope this helps anybody in a similar situation who is unable to use Heparin! Please discuss no Heparin use with your doctor because its use is largely dependent on your blood clotting history and diagnoses.