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

1 Introduction

2 Objectives

Methods3

Results4

Outline

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Conclusions5

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

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

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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Thank You Very Much for Your Attention!

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