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Tunnelled catheter locking with heparin: Comparative study of slow and rapid administration
Vanesa Fernandez
Head nurse
Fresenius Medical Care Services Cartagena y San Pedro del Pinatar, Spain
Malmö, 3 September 2013
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1 Introduction
2 Objectives
Methods3
Results4
Outline
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Conclusions5
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Introduction (1)
Tunneled catheter
• Increasing incidence and prevalence
Advantages
• Immediate use
• Sometimes it is the only choice of vascular access (diabetic patients, metabolic diseases, vascular dysfunction, severe cardiovascular disease).
Infectious and mechanical complications
Objective:
• To obtaining higher Qb (as much as possible), usually lower than AV-Fistula (AVF)
• To maintain patency of the tunneled catheter, as this is critical to get ahigh Qb
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Introduction (2)
Locking
One of the major goal is to ensure permeability of the catheter between hemodialysis sessions by means of sealing.
PREVENT RETROGRADE FILLING OF THE LUMEN
AVOID THROMBOSIS
MAINTAIN PERMEABILITY ↑ QB ↑ DOSAGE OF DIALYSIS
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Objectives
The Spanish Society of Nephrology Guidelines recommend locking with a sodium heparin concentration of 20 U/ml, or - if this is not available - 1% heparin.
Opinions on the locking regime differ: Conventional slow regime (HEPS) or a rapid regime with fast clamping (HEPR)
Objective: To compare the efficacy and complications of the session with both methods.
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Methods (1)
• 32 patients recruited, mean age 66.3 years, 60% male patients, 53.2 months of haemodialysis
• 37% vascular and diabetic cases, 25 patients completed the study. All patients have tunneled central venous catheters.
• We performed a prospective cross-over study in a prevalent haemodialysis population (2 centers). All patients gave their informed consent to participate in the study.
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Methods (2)
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16 patientsHEPS
8 weeks
16 patientsHEPR
8 weeks
16 patientsHEPR
8 weeks
16 patientsHEPS
8 weeksDESIGN
Dialysis efficacy variables: Qb, Kt, VTR
Complication related variables: Urokinase requirements and times, investment of branches, additional washes and recovery arterial and venous cap
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Results: Efficacy (1)
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Results: Efficacy (2)
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Results: Complications (at least in one session)
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p=0.001
p=0.002
p=0.003p=0.001
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Results
o Among the patients where the plug was not removed and additional flushes were needed the number does not differ significantly.
o There were no significant differences in the number of urokinase protocols
o However, investment for branches is higher (p=0.024) with HEPR (6.73±3.11) than HEPS (1.25±1.30).
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Conclusions (1)
No differences were noted in dialysis efficacy between dialysis catheter lock with heparin administered slowly versus quickly with positive pressure, nor in Qb, Kt, duration or TRV.
So, both methods are able to maintain lumen permeability in patients with tunneled permanent catheters as vascular access for haemodialysis or on-line haemodiafiltration.
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Conclusions (2)
Nevertheless, there were fewer complications with the slow administration regarding the need of urokinase, additional flushes, dialysis session with inverted branches, or difficulty in plug recovery.
Therefore, based on these results we recommend the slow administration method as elective procedure.
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FME © Copyright - Comparative assessment of nutritional status in haemodialysed... Page 14
Thank You Very Much for Your Attention!
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Acknowledgments
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Javier Fernández-Caro NurseFresenius Medical Care Dialysis Centre, Cartagena, Spain.
Rosario Perez NurseFresenius Medical Care Dialysis Centre. Caritagena, Spain
Tania Ortega NurseFresenius Medical Care Dialysis Centre. San Pedro del Pinatar, Spain
Rhoda Pallares NurseFresenius Medical Care Dialysis Centre. Caritagena, Spain
Maria Teresa Parisotto Director, Nursing Care ManagementFresenius Medical Care - NephroCare Coordination, Bad Homburg, Germany
EDTNA/ERCA, Malmö 31 August - 3 September 2013