Locked Away—Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis

Abstract

Reliable vascular access is necessary for effective hemodialysis. Guidelines recommend chronic hemodialysis via an arteriovenous fistula (AVF), however, in a significant number of patients, permanent central venous catheters (CVCs) are used. The use of a tunneled catheter is acceptable if the estimated dialysis time is less than a year or it is not possible to create an AVF. The main complications associated with CVC include thrombosis and catheter-related bloodstream infections (CRBSIs), which may result in loss of vascular access. The common practice is to use locking solutions to maintain catheter patency and minimize the risk of CRBSI. This paperwork summarizes information on currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction. The PubMed database was systematically searched for articles about locking solutions used in permanent CVCs in hemodialysis patients. Additional studies were identified by searching bibliographies and international guidelines. Articles on end-stage kidney disease patients dialyzed through a permanent CVC were included. Information from each primary study was extracted using pre-determined criteria including thrombotic and infectious complications of CVC use, focusing on permanent CVC if sufficient data were available. Of the currently available substances, it seems that citrate at a concentration of 4% has the best cost-effectiveness and safety profile, which is reflected in the international guidelines. Recent studies suggest the advantage of 2+1 protocols, i.e., taurolidine-based solutions with addition of urokinase once a week, although it needs to be confirmed by further research. Regardless of the type of locking solution, if prophylaxis with a thrombolytic agent is chosen, it should be started from the very beginning to reduce the risk of thrombotic complications. In case of CVC dysfunction, irrespective of the thrombolysis attempt, catheter replacement should be planned as soon as possible.

Taurolidine-related adverse events in patients on home parenteral nutrition frequently indicate catheter-related problems

“…Five (total of 65 patients) found no AEs [15,19e22], while four studies (450 patients) observed 45 patients (10%) with drug-related AEs [12e14,23], mainly pain, taste changes, dyspnea and nausea, vomiting or anorexia. These symptoms corroborate the findings of our study and those reported in oncology and dialysis patients [24,25].…”

Infecciones asociadas a catéter venoso central en adultos en proceso de hemodiálisis

“…Las directrices recomiendan la HD crónica a través de una FAV; sin embargo, en un número importante de pacientes se utilizan CVC permanentes. El uso de un catéter tunelizado es aceptable si el tiempo estimado de HD es inferior a un año o no es posible crear una FAV (33,34) . Como siempre lo mencionan los diferentes estudios referenciados, las complicaciones más comunes del CVC para HD son las infecciones del torrente sanguíneo relacionadas con el CVC de ahí la importancia en determinar las variables y la prevalencia de las infecciones (35) .…”

Study on PTFE Superhydrophobic Coating Modified by IC@dMSNs and its Enhanced Antibacterial Effect

“…Placing central venous catheter, hemodialysis catheter and radial artery catheter, long-term intravenous uid infusion, central venous pressure and arterial monitoring, hemodialysis and ECMO are important treatment methods in emergency and critical care departments (1)(2)(3). However, catheter-related infections and thrombosis are common and serious complications after implantation (4), and effective anticoagulation is usually needed in clinical practice to prevent and treat problems such as thrombosis (5)(6)(7)(8)(9). But once a catheter infection occurs, it is necessary to remove the catheter, conduct catheter end and blood culture to determine the source of infection and bacterial species, use effective antibiotics, and reinsert the catheter in another location.…”