Exit of catheter lock solutions from double lumen acute haemodialysis catheters an in vitro study

Sungur, Murat; Eryüksel, Emel; Yavas, Sinan; Bïhorac, Azra; Layon, A. Joseph; Caruso, Lawrence J.

doi:10.1093/ndt/gfm452

Cited by 48 publications

(53 citation statements)

References 9 publications

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“…No catheter seems to be free of this problem. An in vitro study of five different double lumen catheters showed that systemic leakage was greatest with 20% overfill (34).…”

Section: Maintaining Patency With Catheter Locking Solutions Between mentioning

confidence: 99%

Catheter Management in Hemodialysis Patients

Besarab

Pandey²

2011

Clinical Journal of the American Society of Nephrology

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SummaryOver 330,000 individuals in the United States depend on hemodialysis (HD), the majority as a result of endstage renal disease. Sustainable vascular access can be achieved through arteriovenous fistulas, arteriovenous grafts, or tunneled catheters. Tunneled dialysis catheters (TDCs) often remain in use for months or even years, long beyond their initial intended use as a bridging device. Research efforts are focused on identifying strategies to prevent/minimize the risk of the most common catheter-related complications: thrombotic occlusion and infection. Thrombotic occlusion of TDCs prevents adequate dialysis but can be managed successfully through thrombolytic agents to restore/improve blood flow in the majority of patients, allowing immediate HD delivery and prolonging usability of the TDC. Occasionally, catheter exchange with fibrin sheath disruption is needed to preserve the site. Surface-treated catheters could improve the morbidity and mortality associated with HD delivery via an indwelling catheter, but results from studies have been disappointing to date. We review the etiology of catheter-based access failure and the monitoring and interventional steps that should be taken to maintain the patency and safety of catheters for HD. Wherever possible we note the areas in which there is scant data where further randomized clinical trials are needed.

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“…No catheter seems to be free of this problem. An in vitro study of five different double lumen catheters showed that systemic leakage was greatest with 20% overfill (34).…”

Section: Maintaining Patency With Catheter Locking Solutions Between mentioning

confidence: 99%

Catheter Management in Hemodialysis Patients

Besarab

Pandey²

2011

Clinical Journal of the American Society of Nephrology

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“…However, a major complication of heparin locks, especially in the perioperative period, is bleeding due to unsuspected anticoagulation [58]. This is the result of leakage of lock solution from the catheter due to parabolic flow patterns in the catheter [59,60]. Trisodium citrate (30%) is an intraluminal locking agent that has been shown to significantly reduce the rate of CRB [61].…”

Section: B Preventing Contamination Of the Catheter Hubmentioning

confidence: 99%

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Stefanidis

2009

Pediatr Nephrol

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This editorial commentary discusses the strategies for prevention of catheter-related bacteremia (CRB) in children on hemodialysis, which is associated with high morbidity and the increase of hospital cost. There is evidence that the use of arteriovenous fistulae in children on hemodialysis is associated with lower infection rates. Therefore, the use of catheters in these patients should be decreased by improving arteriovenous fistulae use rates or by increasing peritoneal dialysis patient recruitment. However, despite the wide adoption of such policies, hemodialysis catheters are still being used in a significant number of cases. For these patients, implementation of effective strategies for preventing contamination of the catheter hub should be a priority. The appropriate recording and evaluation of CRB rates are important for assessing preventive policies. In addition, the successful management of a CRB is essential for preventing recurrence of bacteremia. Recently it was documented in a number of randomized clinical trials that antimicrobial lock solutions were effective for preventing CRB. It is suggested that the use of antimicrobial locks should be considered in children who are at high risk of developing CRB, with caution for their long-term use, because of the possibility of bacterial resistance. Now is the time for action, and all preventive steps should be performed simultaneously to minimize the risk of CRB.

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“…An aliquot of the catheter solution invariably leaks into the systemic circulation (3,4). As a result, higher heparin lock concentrations have the potential to cause systemic bleeding caused by inadvertent systemic anticoagulation (5,6). A recent study reported a higher frequency of hemorrhagic complications after placement of a new dialysis catheter in patients receiving a high-concentration heparin lock (7).…”

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confidence: 99%

Does the Heparin Lock Concentration Affect Hemodialysis Catheter Patency?

Ivan

Smith

Allon

2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Concentrated heparin solutions are instilled into the catheter lumens after each hemodialysis session to prevent catheter thrombosis. The heparin lock concentration at many centers has been decreased recently to reduce the risk of systemic bleeding and contain costs. However, the effect of this change on catheter patency is unknown. We compared catheter patency between two heparin lock solutions: 1000 versus 5000 units/ml. Design, setting, participants, & measurements: With use of a prospective, computerized, vascular access database, 105 patients with newly placed tunneled hemodialysis catheters, including 58 patients receiving a 5000 units/ml heparin lock and 47 patients receiving a 1000 units/ml heparin lock, were retrospectively identified. The primary endpoint was cumulative catheter patency and the secondary endpoint was frequency of thrombolytic instillation.Results: Cumulative catheter survival was similar in the two groups, being 71% versus 73% at 120 days in the low-and high-concentration heparin lock groups (hazard ratio of catheter failure, 0.97; 95% confidence interval, 0.45 to 2.09; P ‫؍‬ 0.95). The frequency of tissue plasminogen activator instillation was significantly greater in the low-concentration heparin group (hazard ratio, 2.18; 95% CI, 1.26 to 3.86; P ‫؍‬ 0.005). No major bleeding complications were observed in either treatment group. The overall drug cost for maintaining catheter patency was 23% lower with the low-concentration heparin lock ($1418 versus $1917) to maintain catheter patency for 1000 days.Conclusions: Low-concentration heparin lock solutions do not decrease cumulative dialysis catheter patency, but require a twofold increase in thrombolytic instillation to maintain long-term patency.

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Exit of catheter lock solutions from double lumen acute haemodialysis catheters an in vitro study

Cited by 48 publications

References 9 publications

Catheter Management in Hemodialysis Patients

Catheter Management in Hemodialysis Patients

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Does the Heparin Lock Concentration Affect Hemodialysis Catheter Patency?

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