Is repeated flushing of Hickman catheters necessary?
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Sterilising tablets are 16 mm in diameter, and the severity of the reaction in case 2 was probably due to the tablet sticking in the supraglottis. Hawkins et a! stated that solid caustic agents produce a higher incidence of oesophageal burns than liquids.3 The changes in the bronchi were probably due to inhalation of chlorine gas, which is generated when sodium dichloroisocyanurate is dissolved in water. Sodium dichloroisocyanurate is the active component of sterilising tablets, and the solution it produces is of about neutral pH. The mechanism of injury is assumed to be the oxidation of proteins, as it is after ingestion of liquid chlorine bleaches. I As the ingestion of sterilising tablets is relatively common and the consequences potentially fatal it would be prudent to package the tablets in childproof containers like other medications.
[1] W. P. Reed,et al. Prolonged venous access for chemotherapy by means of the hickman catheter , 2006, Cancer.
[2] D. Steed,et al. Indwelling venous access catheters in patients with acute leukemia , 1984, Cancer.
[3] J. F. Wade,et al. USE OF MODIFIED SUBCUTANEOUS RIGHT-ATRIAL CATHETER FOR VENOUS ACCESS IN LEUKÆMIC PATIENTS , 1980, The Lancet.