Evaluation of anti-Xa activity after injection of a heparin lock for dialysis catheters in intensive care: A prospective observational study

Bovet, Julien; Soudry-Faure, Agnès; Merdji, Hamid; Ksiazek, Eléa; Quenot, Jean‐Pierre; Meziani, Ferhat; Cransac, Amélie; Helms, Julie

doi:10.1016/j.thromres.2020.02.006

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Bong et al 20 showed that the activated partial thromboplastin time (APTT) was considerably raised after heparin locking of catheter lumens. In the VERROUHEMOST study, 21 Bovet et al reported that there was a median increase in anti‐Xa activity of 0.37 IU/ml (Q1; Q3: 0.20;0.67) after injection of the heparin lock solution ( p < 0.0001), with an increase in anticoagulation levels in two‐thirds of samples, supporting the hypothesis that there is passage of heparin into the bloodstream after injection of a heparin lock.…”

Section: Discussionmentioning

confidence: 87%

“… 27 It is particularly suited to prolonged use, as may be the case for hemodialysis via tunneled catheters, which may remain in place for months, even years. In theory, there is no excess risk in patients with acute kidney injury, particularly of metabolic disorders such as hypocalcemia, 21 on condition that best practices are observed, notably slow injection using the quantities indicated on the catheter arms.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of locking solutions for non‐tunneled hemodialysis catheters

Boucley¹,

Dargent

Andreu³

et al. 2022

Hemodialysis International

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Background: We conducted a systematic review of studies investigating lock solutions for use in non-tunneled hemodialysis catheters. Methods: We searched PubMed and Cochrane databases from inception to June 11, 2021. Study inclusion criteria were: randomized trial or observational study, adults (>18 years), with acute kidney injury (AKI); and temporary non-tunneled catheters. We recorded bleeding events, catheter dysfunction and complications.Results: Of 649 studies identified, 6 were included (4 randomized, 1 nonrandomized trial, 1 retrospective cohort study; sample sizes 78-1496 patients). Citrate was compared to heparin in 4 studies, to saline in 1, and ethanol versus saline in 1. Event-free survival of non-tunneled catheters did not differ between groups.Catheter-related infections and adverse events were less frequent with citrate locks, but reached statistical significance in only two studies. Conclusion: Existing data are too heterogeneous to enable recommending one type of catheter lock over any other for non-tunneled hemodialysis catheters.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Systematic review of locking solutions for non‐tunneled hemodialysis catheters

Boucley¹,

Dargent

Andreu³

et al. 2022

Hemodialysis International

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“…In fact, iatrogenic bleeding caused by heparin sealing is very rare, and the metabolic half-life of heparin is in 1 h-2 h (Niyyar & Lok, 2013). Some studies (Bovet et al, 2020;You et al, 2017) At the same time, the occurrence of phlebitis is related to the configuration of sealing fluid, the compliance of aseptic principle in sealing operation, the personal hygiene of the children, and the condition of blood vessels (Rosenbluth et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Heparin versus normal saline for the care of peripheral intravenous catheters in children: A meta‐analysis

Zhang,

Wei,

Chai

et al. 2023

Nursing Open

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AimTo conduct a meta‐analysis to evaluate the role of heparin versus normal saline lock in the care of peripheral intravenous catheters.DesignA meta‐analysis.MethodsThis meta‐analysis searched nine databases for randomized controlled trials (RCTs) on heparin versus normal saline for the care of peripheral intravenous catheters in children up to April 5, 2023. The quality of included RCTs was evaluated using the risk of bias tool of Cochrane library. RevMan5.3 software was used for data analysis.ResultsTen RCTs with a total of 1255 children were involved. Meta‐analysis indicated that heparin lock reduced the incidence of blockage of peripheral intravenous catheter [OR = 2.01, 95% CI (1.42,2.84), p < 0.001], prolonged the duration of peripheral intravenous catheter indwelling[MD = ‐0.43, 95% CI (−0.75, −0.11), p = 0.008]. There were no statistical differences in the incidence of phlebitis [OR = 1.02, 95% CI (0.59, 1.74), p = 0.95 W].Public contributionHeparin may have more benefits in the nursing care of peripheral intravenous catheters compared with normal saline.

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“…According to encouraging results in ICUs and in hemodialysis patients with tunneled dialysis catheters [47,48], the use of citrate as a catheter lock for RRT catheters seems to be preferred in our study (53% in agreement), despite a recent study [49] and guidelines [20] that preclude any firm conclusion about the best catheter lock to use (isotonic saline solution, ethanol, heparin, citrate, and taurolidine). Heparin remains the only catheter lock with marketing authorization at present, despite the absence of any benefit on catheter survival, and the existence of doubts regarding its innocuousness [50].…”

Section: Discussionmentioning

confidence: 99%

Renal Replacement Therapy for Acute Kidney Injury in French Intensive Care Units: A Nationwide Survey of Practices

et al. 2021

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Background: The frequency of acute kidney injury (AKI) can be as high as 50% in the intensive care unit (ICU). Despite the publication of national guidelines in France in 2015 for the use of RRT, there are no data describing the implementation of these recommendations in real-life. Methods: We performed a nationwide survey of practices from November 15, 2019, to January 24, 2020, in France. An electronic questionnaire based on the items recommended in the national guidelines was sent using an online survey platform, to the chiefs of all ICUs in France. The questionnaire comprised a section for the Department Chief about local organization and facilities, and a second section destined for individual physicians about their personal practices. Results: We contacted the Department Chief in 356 eligible ICUs, of whom 88 (24.7%) responded regarding their ICU organization. From these 88 ICUs, 232/285 physicians (82%) completed the questionnaire regarding individual practices. The practices reported by respondent physicians were as follows: intermittent RRT was first-line choice in >75% in a patient with single organ (kidney) failure at the acute phase, whereas continuous RRT was predominant (>75%) in patients with septic shock or multi-organ failure. Blood and dialysate flow for intermittent RRT were 200–300 mL/min and 400–600 mL/min, respectively. The dose of dialysis for continuous RRT was 25–35 mL/kg/h (65%). Insertion of the dialysis catheter was mainly performed by the resident under echographic guidance, in the right internal jugular vein. The most commonly used catheter lock was citrate (53%). The most frequently cited criterion for weaning from RRT was diuresis, followed by a drop in urinary markers (urea and creatinine). Conclusion: This study shows a satisfactory level of reported compliance with French guidelines and recent scientific evidence among ICU physicians regarding initiation of RRT for AKI in the ICU.

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Evaluation of anti-Xa activity after injection of a heparin lock for dialysis catheters in intensive care: A prospective observational study

Cited by 7 publications

References 9 publications

Systematic review of locking solutions for non‐tunneled hemodialysis catheters

Systematic review of locking solutions for non‐tunneled hemodialysis catheters

Heparin versus normal saline for the care of peripheral intravenous catheters in children: A meta‐analysis

Renal Replacement Therapy for Acute Kidney Injury in French Intensive Care Units: A Nationwide Survey of Practices

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