Sodium citrate 4% locking solution for central venous dialysis catheters--an effective, more cost-efficient alternative to heparin

Grudzinski, Linda; Quinan, Patricia; Kwok, Sophie; Pierratos, Andreas

doi:10.1093/ndt/gfl606

Cited by 114 publications

(110 citation statements)

References 21 publications

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“…The largest experience reported is that from Grudzinski et al (42) during a conversion study from heparin 10,000 U/ml to 4% citrate locks. The rate of flow-related catheter exchange, tPA use, and bacteremia did not differ in the year of heparin locks compared with the subsequent year of citrate locks with over 30,000 catheter days at risk in each period.…”

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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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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“…The FDA also advised that a 4% citrate solution should be used as an alternative [62]. Recently, it has been shown that a 4% citrate solution is effective in maintaining catheter patency [63,64] and has not been demonstrated to induce systemic anticoagulation or hypocalcemia. The same study found that the incidence of CRB before versus after switching from heparin to citrate 4% was similar.…”

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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“…8,9 Given these adverse outcomes and high costs, further research on strategies to optimize the use of hemodialysis catheters is required, particularly with regard to preventing the most common adverse catheter outcomes of malfunction (i.e., inability to initiate or continue dialysis because of to inadequate bloodflow, often the result of catheter thrombosis) and bacteremia. 5,6 Heparin has traditionally been used as an intradialytic catheter locking solution, although other agents are now used, including citrate 10,11 and recombinant tissue plasminogen activator (rt-PA). 12 Intradialytic locking with a thrombolytic agent has many appealing features.…”

mentioning

confidence: 99%

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Manns

Scott-Douglas²,

Ravani

et al. 2014

Journal of the American Society of Nephrology

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In a recent randomized trial, weekly recombinant tissue plasminogen activator (rt-PA), 1 mg per lumen, once per week, and twice-weekly heparin as a locking solution (rt-PA/heparin) resulted in lower risks of hemodialysis catheter malfunction and catheter-related bacteremia compared with thrice-weekly heparin (heparin alone). We collected detailed costs within this trial to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the 6-month trial. Nonparametric bootstrap estimates were used to derive 95% confidence intervals (CIs) and mean cost differences between the treatment groups. The cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. Overall, the difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was Can$323 (95% CI, 2$935 to $1581; P=0.62). When the costs were extrapolated over a 1-year time horizon using decision analysis, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. This finding was sensitive to plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term. In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin. Cost savings due to a lower risk of hospitalization for catheter-related bacteremia partially offset the increased cost of rt-PA.

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Sodium citrate 4% locking solution for central venous dialysis catheters--an effective, more cost-efficient alternative to heparin

Cited by 114 publications

References 21 publications

Catheter Management in Hemodialysis Patients

Catheter Management in Hemodialysis Patients

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

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

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