Rt-PA Beats Heparin -- But Will Bundling Lock it Out?
Rt-PA Beats Heparin -- But Will Bundling Lock it Out?
Prevention of Dialysis Catheter Lumen Occlusion With Rt-PA vs Heparin Study Group
Hemmelgarn BR, Moist LM, Lok CE, et al. N Engl J Med. 2011;364:303-312
Abstract
The maintenance of a working vascular access is an innovation in the provision of dialysis-related care that is desperately needed. Nationally, on average, more than 80% of patients new to hemodialysis who haven't been seen by a nephrologist begin dialysis using a central venous catheter. Even among patients who have been seen by a nephrologist, the number is not much better -- approximately 50%. The risk for bacteremia and sepsis associated with central venous dialysis catheters has been estimated at between 600 and 1200 episodes per 1000 patient-years at risk. Furthermore, patients utilizing catheters have a greater mortality risk than those with a permanent access perhaps due to the risk for infection. Arguably, the problems associated with central venous catheters are life-threatening in some cases and costly in all.
Heparin has traditionally been used to lock the lumens of the access catheter to prevent clotting. In understanding best practices though, one would be hard pressed to determine on what tradition or standard heparin was chosen. Perhaps it was due to widespread availability at the time that catheter technology was first available or because heparin was used in other types of catheters (eg, Hickman catheters). In any case, few other solutions have been tested for efficacy and none have definitively been shown to improve catheter outcomes.
Prevention of Dialysis Catheter Malfunction With Recombinant Tissue Plasminogen Activator
Prevention of Dialysis Catheter Lumen Occlusion With Rt-PA vs Heparin Study Group
Hemmelgarn BR, Moist LM, Lok CE, et al. N Engl J Med. 2011;364:303-312
Abstract
The maintenance of a working vascular access is an innovation in the provision of dialysis-related care that is desperately needed. Nationally, on average, more than 80% of patients new to hemodialysis who haven't been seen by a nephrologist begin dialysis using a central venous catheter. Even among patients who have been seen by a nephrologist, the number is not much better -- approximately 50%. The risk for bacteremia and sepsis associated with central venous dialysis catheters has been estimated at between 600 and 1200 episodes per 1000 patient-years at risk. Furthermore, patients utilizing catheters have a greater mortality risk than those with a permanent access perhaps due to the risk for infection. Arguably, the problems associated with central venous catheters are life-threatening in some cases and costly in all.
Heparin has traditionally been used to lock the lumens of the access catheter to prevent clotting. In understanding best practices though, one would be hard pressed to determine on what tradition or standard heparin was chosen. Perhaps it was due to widespread availability at the time that catheter technology was first available or because heparin was used in other types of catheters (eg, Hickman catheters). In any case, few other solutions have been tested for efficacy and none have definitively been shown to improve catheter outcomes.
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