Filling Hemodialysis Catheters in the Interdialytic Period: Heparin Versus Citrate Versus Polygeline: A Prospective Randomized Study

Abstract

Heparin and saline are commonly used to fill hemodialysis central venous catheters to prevent their thrombosis during the interdialytic period. The purpose of this prospective clinical study was to evaluate whether replacing heparin with citrate or polygeline could ensure satisfactory catheter function without exposing patients to the risk of systemic heparinization. Thirty end-stage renal disease (ESRD) patients with subclavian or jugular single lumen catheters as temporary vascular access for hemodialysis were enrolled. After the insertion of the catheters, the patients were randomly assigned to one of the following three filling groups: Group A, heparin; Group B, citrate; Group C, polygeline. Before each dialysis, the filling solution was aspirated and clot volume, if present, was measured. The catheter usage time and the clot volume were 23 +/- 24 days and 0.052 +/- 0.035 ml in Group A, 51 +/- 36 days and 0.059 +/- 0.032 ml in Group B, and 32 +/- 10 days and 0.056 +/- 0.038 ml in Group C, respectively. Our results indicate that citrate or polygeline can replace heparin effectively as a filling solution for single lumen temporary hemodialysis catheters.

Comparação entre citrato trissódico e heparina como solução para selo de cateter em pacientes em hemodiálise

“…14,15,16,17 Some studies, however, showed no difference regarding citrate or heparin use. 18,19,20 One of such studies, a randomized and controlled one, reported no citrate superiority over heparin; however, the authors attributed such result to the low occurrence of events in both groups (lower than 0.7 bacteremia episodes/1,000 catheters.day). 21 In the present study, the incidence of bacteremia was significantly reduced in the Citrate Group, which did not occur with pyrogenic episodes, probably because the bactericidal action of trisodium citrate is restricted to the catheter lumen.…”

Heparin Stimulates Staphylococcus aureus Biofilm Formation

“…Additionally, alternative lock solutions should be and are being tested both in the laboratory and in clinical settings (7,52,55,59,64).…”

Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

“…13,38,117,118 One further systematic review 119 was published after the searches were complete, and contained four further studies. 99,[120][121][122] Only one of these, involving gentamicin (total 140 patients), 99 was an RCT and contained data that could be used in the meta-analysis. In total, we found eight systematic reviews.…”