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Fan Y, He D, Cheng J, Wu Z, Hao Y, Liu H. Successful Removal and Replacement of a Stuck Hemodialysis Catheter via Thoracotomy: Report of Two Cases and Literature Review. Case Rep Nephrol Dial 2024; 14:56-63. [PMID: 38571812 PMCID: PMC10990479 DOI: 10.1159/000537740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Stuck tunneled central venous catheters (CVCs) have been increasingly reported. In rare cases, the impossibility of extracting the CVC from the central vein after regular traction is the result of rigid adhesions to the surrounding fibrin sheath. Forced traction during catheter removal can cause serious complications, including cardiac tamponade, hemothorax, and hemorrhagic shock. Knowledge and experience on how to properly manage the stuck catheter are still limited. Case Presentation Here, we present two cases that highlight the successful removal of the stuck tunneled CVC via thoracotomy through the close collaboration of multidisciplinary specialists in the best possible way. Both patients underwent an unsuccessful attempt at thrombolytic therapy with urokinase, catheter traction under the guidance of digital subtraction angiography and intraluminal balloon dilation. And we reviewed the literature on stuck catheters in the hope of providing knowledge and effective approaches to attempted removal of stuck catheters. Conclusion There is no standardized procedure for dealing with stuck catheters. Intraluminal percutaneous transluminal angioplasty should be considered as the first-line treatment, while open surgery represents a second option only in the event of failure. Care must be taken that forced extubation can cause patients life-threatening.
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Affiliation(s)
- Yanqin Fan
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dejiao He
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Cheng
- Division of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenzhong Wu
- Division of Interventional Radiography, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiqun Hao
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Liu
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
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Xu T, Zeng N, Li N. Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem. Front Cardiovasc Med 2023; 10:1063450. [PMID: 37663415 PMCID: PMC10471148 DOI: 10.3389/fcvm.2023.1063450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The aim of this study was to evaluate the causes of the dysfunctional tunneled cuffed catheters (TCCs) using multi-spiral computed tomography venography (MSCTV), and to analyze the outcomes of endovascular salvage techniques. Material and methods This retrospective review data from 27 patients who experienced TCC dysfunction between July 1, 2016 and January 31, 2021 was conducted. Patients' demographic data, clinical signs and symptoms, and imaging data were collected from interventional radiology database. Results MSCTV showed a range of abnormalities in the hemodialysis (HD) patients, including central venous occlusion (n = 4), fibrin sheath formation (n = 3), malposition of the catheter tips (n = 4), central venous perforation (n = 1), thrombus formation (n = 12), regular catheter exchange without determined lesions (n = 3). Interventional catheter salvage procedures were performed, such as catheter exchange, balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, and stent deployment. The technical success rate for catheter insertions was 100%, and no procedure-related severe complications were observed. The 30-day catheter patency for all assessable catheters was 85.2%. Conclusion The use of MSCTV showed abnormal findings in almost 88.9% of cases concerning dysfunctional TCC. In this study, the examined appropriate endovascular techniques were found to be safe and technically successful, with a low incidence of procedure-related complications.
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Affiliation(s)
- Tao Xu
- Department of Interventional Radiology, Shenzhen People’s Hospital, The Second Clinical Medical College,Jinan University, The First Affiliated Hospital, Southern University of Science and Technology
| | - Ni Zeng
- Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nan Li
- Department of Interventional Radiology, Guangzhou First People’s Hospital, Guangzhou, China
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Vassallo M, Denis E, Manni S, Lotte L, Fauque P, Sindt A. Treatment of long-term catheter-related bloodstream infections with short-course Daptomycin lock and systemic therapy associated with Taurolidine-lock: A multicenter experience. J Vasc Access 2023:11297298231152500. [PMID: 36726226 DOI: 10.1177/11297298231152500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Few studies describe the efficacy of antibiotic lock therapy (ALT) in long-term catheter-related bloodstream (CRBSI) infections. We applied local protocols combining Daptomycin (DPT) and Taurolidine ALT, associated with systemic antibiotic treatment (SAT), for conservative management of coagulase-negative Staphylococci (CoNS) CRBSI. METHODS Patients admitted for CoNS-associated CRBSI and treated with DPT and Taurolidine as ALT were retrospectively analyzed. Success was defined as catheter retention 30 days after ending treatment. Catheter removal within 30 days was considered as failure. RESULTS From April 2018 to September 2021, 22 subjects with CoNS-associated-CRBSI were included (95% with cancer, mean age 64 years, 59% male). Staphylococcus epidermidis was isolated in 82% of cases. Mean duration of DPT was 3.9 and 3 days as ALT and SAT, respectively. SAT also included Rifampin for 3 days. Taurolidine ALT was started on day 4 and was combined with oral SAT, that is, either Linezolid or Tedizolid. Mean duration of Taurolidine was 10.5 days, while total antibiotic treatment lasted 13.5 days. Clinical success and failure rates were 95% and 5%, respectively. DISCUSSION Short course DPT as ALT, combined with SAT and Taurolidine ALT, allowed high rates of conservative management of catheters in case of CoNS-associated-CRBSI.
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Affiliation(s)
- Matteo Vassallo
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Eric Denis
- Department of Internal Medicine, Antibes General Hospital, Antibes, France
| | - Sabrina Manni
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Laurene Lotte
- Multipurpose Laboratory, Bacteriology and Virology Unit, Cannes General Hospital, Cannes, France
| | | | - Audrey Sindt
- Multipurpose Laboratory, Bacteriology and Virology Unit, Cannes General Hospital, Cannes, France
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Wang Y, Sun X. Reevaluation of lock solutions for Central venous catheters in hemodialysis: a narrative review. Ren Fail 2022; 44:1501-1518. [PMID: 36047812 PMCID: PMC9448397 DOI: 10.1080/0886022x.2022.2118068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND A significant proportion of incident and prevalent hemodialysis patients have central venous catheters for vascular access. No consensus is available on the prevention of catheter dysfunction or catheter-related bloodstream infections in patients undergoing hemodialysis by means of catheter lock solutions. METHOD We reviewed the effects of single and combined anticoagulants with antibacterial catheter lock solutions or other antimicrobials for the prevention of thrombosis or infections in hemodialysis patients. Relative risks with 95% confidence intervals for trials of the same type of catheter locking solution were pooled. SOURCES OF INFORMATION We included original research articles in English from PubMed, EMBASE, SpringerLink, Elsevier and Ovid using the search terms 'hemodialysis,' 'central venous catheter,' 'locking solution,' 'UFH,' 'low molecular weight heparin,' 'EDTA,' 'citrate,' 'rt-PA,' 'urokinase,' 'gentamicin,' 'vancomycin', 'taurolidine,' 'sodium bicarbonate,' 'hypertonic saline' and 'ethanol' and 'catheter'. FINDINGS Low-dose heparin lock solution (< 5000 U/ml) can efficiently achieve anticoagulation and will not increase the risk of bleeding. Low-concentration citrate (< 5%) combined with rt-PA can effectively prevent catheter infection and dysfunction. Catheter-related infections may be minimized by choosing the appropriate antibiotic and dose. LIMITATIONS There is a lack of follow-up validation data for LMWH, EDTA, taurolidine, sodium bicarbonate, ethanol, and other lock solutions. IMPLICATIONS Since catheterization is common in hemodialysis units, studies on long-term treatment and preventative strategies for catheter dysfunction and catheter-related infection are warranted.
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Affiliation(s)
- Yiqin Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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Fontseré N, Soriano A, Mestres G, Bermudez P, Zarco F, Lozano V, Rodas L, Broseta J, Arias M, Maduell F. Efficacy of systematic catheter locks solution of taurolidine/heparin versus taurolidine/urokinase in end-stage renal insufficiency stage 5D. Nefrologia 2022; 42:611-613. [PMID: 36669952 DOI: 10.1016/j.nefroe.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 06/17/2023] Open
Affiliation(s)
- Néstor Fontseré
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain.
| | - Alex Soriano
- Unidad Funcional de Acceso Vascular, Servicio de Enfermedades Infecciosas, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Gaspar Mestres
- Unidad Funcional de Acceso Vascular, Servicio de Cirugía Vascular, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Patricia Bermudez
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Federico Zarco
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Valentín Lozano
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Jose Broseta
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Marta Arias
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Francisco Maduell
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, Spain
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Antimicrobial activity of hemodialysis catheter lock solutions in relation to other compounds with antiseptic properties. PLoS One 2021; 16:e0258148. [PMID: 34618850 PMCID: PMC8496847 DOI: 10.1371/journal.pone.0258148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Proper protection of vascular access after haemodialysis is one of the key measures for the prevention of catheter-related infections. Various substances with bactericidal and anticoagulant properties are used to fill catheters, but due to the unsatisfactory clinical effects and occurrence of adverse reactions, the search for new substances is still ongoing. In the present paper, we compared the in vitro antimicrobial activity of solutions used for tunnelled catheter locking (taurolidine, trisodium citrate) and solutions of substances that could potentially be used for this purpose (sodium bicarbonate, polyhexanide-betaine). The studies have been conducted on bacteria that most commonly cause catheter-related infections. The values of both minimum inhibitory concentration and minimum biofilm eradication concentration of the substances were determined. The ability of the tested substances to eradicate biofilm from the dialysis catheter surface was also evaluated. The results showed that polyhexanide-betaine inhibited the growth of all microbes comparably to taurolidine, even after ≥ 32-fold dilution. The activity of trisodium citrate and sodium bicarbonate was significantly lower. Polyhexanide exhibited the highest activity in the eradication of bacterial biofilm on polystyrene plates. The biofilm formed on a polyurethane dialysis catheter was resistant to complete eradication by the test substances. Polyhexanide-betaine and taurolidine showed the highest activity. Inhibition of bacterial growth regardless of species was observed not only at the highest concentration of these compounds but also after dilution 32–128x (taurolidine) and 32–1024x (polyhexanide-betaine). Therefore, it can be assumed that taurolidine application as a locking solution prevents catheter colonization and systemic infection development. Taurolidine displays high antimicrobial efficacy against Gram-positive cocci as well as Gram-negative bacilli. On the contrary, the lowest antibacterial effect displayed product contained sodium bicarbonate. The inhibitions of bacterial growth were not satisfactory to consider it as a substance for colonization prevention. Polyhexanidine-betaine possessed potent inhibitory and biofilm eradication properties comparing to all tested products. PHMB is applied as a wound irrigation solution worldwide. However, based on our results, we assume that the PHMB is a promising substance for catheter locking solutions thanks to its safety and high antimicrobial properties.
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Selçuk E, Arıkan AA, Bayraktar FA. Outcomes of Thrombolytic Therapy of Tunnelled Hemodialysis Catheter Dysfunction. Vasc Endovascular Surg 2021; 55:811-816. [PMID: 34121518 DOI: 10.1177/15385744211023292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intraluminal thrombolytic therapy is the first step treatment of thrombotic malfunction of tunneled hemodialysis catheters (THC). The factors that affect catheter restoration and also catheter survival following thrombolytic therapy are not well described. In this study, we aimed to reveal the predictors that affect the success of the procedure and also present post-restoration catheter patency after intraluminal thrombolytic administration. METHOD This retrospective study included 62 patients with tunneled THC thrombosis treated with alteplase between 2017 and2020 in the study center. Age, comorbidities, the use of antiplatelet and anticoagulants, a history of catheter thrombosis, time on dialysis, the duration of the catheter were investigated as possible predictors of procedural success. The independent predictive factors for procedural success were evaluated by using backward stepwise likelihood ratio logistic regression analysis. Primaryand assisted patencieswere presented with Kaplan-Meier graphs. RESULTS Thrombolityc was administered to 62 patients 102 times. The median primary patency from the first thrombolytic administration to a second catheter thrombosis was 9 months (range 1-20 months). The overall median patency was 12 months (range 2-23 months). The overall procedural success rate was 79.4% (81/102).Multivariate analyses revealed that a history of prior catheter thrombosis was the only risk factor for procedural success (OR: 0.49; 95% CI: 0.26-0.91; p = 0.004). The need for a second dwell time among patients with prior history of thrombolysis was significantly higher compared to patients without a history of catheter thrombosis (12/26 patients, 46.2% and 6/55 patients, 10.9%; respectively; p = 0.001). CONCLUSION The success of thrombolysis in subsequent de novo THC thrombosis decreases in patients who previously required intraluminal thrombolytic administration. Identifying patient subgroups with a high risk for THC thrombosis may be useful to investigate effective secondary prevention strategies.
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Affiliation(s)
- Emre Selçuk
- Department of Cardiovascular Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ali Ahmet Arıkan
- Department of Cardiovascular Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Fath Avni Bayraktar
- Department of Cardiovascular Surgery, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Fontseré N, Soriano A, Mestres G, Bermudez P, Zarco F, Lozano V, Rodas L, Broseta J, Arias M, Maduell F. Efficacy of systematic catheter locks solution of taurolidine/heparin versus taurolidine/urokinase in end-stage renal insufficiency stage 5D. Nefrologia 2021; 42:S0211-6995(21)00087-4. [PMID: 34034903 DOI: 10.1016/j.nefro.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Néstor Fontseré
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España.
| | - Alex Soriano
- Unidad Funcional de Acceso Vascular, Servicio de Enfermedades Infecciosas, Hospital Clínico de Barcelona, Barcelona, España
| | - Gaspar Mestres
- Unidad Funcional de Acceso Vascular, Servicio de Cirugía Vascular, Hospital Clínico de Barcelona, Barcelona, España
| | - Patricia Bermudez
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, España
| | - Federico Zarco
- Unidad Funcional de Acceso Vascular, Servicio de Radiología Vascular Intervencionista, Hospital Clínico de Barcelona, Barcelona, España
| | - Valentín Lozano
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Lida Rodas
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Jose Broseta
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Marta Arias
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
| | - Francisco Maduell
- Unidad Funcional de Acceso Vascular, Servicio de Nefrología, Hospital Clínico de Barcelona, Barcelona, España
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Locked Away-Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis. J Clin Med 2021; 10:jcm10112230. [PMID: 34063913 PMCID: PMC8196553 DOI: 10.3390/jcm10112230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
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.
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Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. PLoS One 2021; 16:e0251793. [PMID: 34015014 PMCID: PMC8136626 DOI: 10.1371/journal.pone.0251793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. Methods Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function. Results 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23–0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis. Conclusions Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis. Trial registration ClinicalTrials.gov Identifier: NCT02036255.
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The Effect of Preparing Dialysis Machine Using Normal Saline-Heparin on the Dialysis Adequacy of Hemodialysis Patients: A Crossover, Two-Group, and Randomized Clinical Trial. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.112475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with end-stage renal disease (ESRD) need adequate dialysis. Thus, identification of the ways to enhance dialysis adequacy is very important. Objectives: The present study was conducted to examine the effect of preparing a dialysis machine using a normal saline heparin method on the dialysis adequacy of hemodialysis patients. Methods: This study was conducted in Hamadan in 2019. A total of 36 patients with hemodialysis were selected using convenience sampling who were assigned to the control and intervention groups. The hemodialysis machine was primed for one month using a routine method (control) and one month using a normal saline-heparin method (intervention). Urea reduction ratio (URR) and Kt/V indices were calculated at the beginning and end of each month in the intervention and control groups. Data were analyzed using paired and independent t-test. Results: In the normal saline-heparin group, KT/V showed a statistically significant difference before and after the treatment (P = 0.013), as well as an increase in the KT/V. The URR as the mean dialysis adequacy showed a statistically significant difference (P = 0.004) between the normal saline group and the normal saline-heparin group before and after the treatment. Moreover, URR in the normal saline-heparin group increased after the treatment. In the normal saline treatment group, KT/V and URR decreased after the treatment. In the normal saline group, URR decreased after the treatment. Conclusions: Applying the hemodialysis machine preparation with a normal saline-heparin method increased dialysis adequacy in the patients who underwent hemodialysis.
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Jiménez Hernández M, Soriano A, Filella X, Calvo M, Coll E, Rebled JM, Poch E, Graterol F, Compte MT, Maduell F, Fontsere N. Impact of locking solutions on conditioning biofilm formation in tunnelled haemodialysis catheters and inflammatory response activation. J Vasc Access 2020; 22:370-379. [PMID: 32691665 DOI: 10.1177/1129729820942040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The surface of tunnelled cuffed catheters provides an optimal environment for the development of biofilms, which have recently been described as conditioning films because of the presence of adherent biological materials. These biofilms are associated with infection and thrombosis and potentially increase patients' inflammatory response. These complications could be reduced by the use of locking solutions. OBJECTIVE To analyse biofilm formation, using confocal and electron microscopy, in tunnelled cuffed catheters locked with three different solutions and to determine the relationship between these solutions and inflammatory response. STUDY DESIGN This prospective study included 35 haemodialysis patients with tunnelled cuffed catheter removal for non-infection-related reasons. The participants were divided into three groups according to the lock solution used: (1) heparin 1: 5000 IU; (2) citrate 4%; and (3) taurolidine 1.35%, citrate 4% and heparin 500 IU (taurolock); in the latter group, 25,000 IU taurolidine-urokinase was used in the last weekly session. All tunnelled cuffed catheters were cultured, and the inner surface was evaluated with confocal and electron microscopy. The inflammatory profile of included patients was determined at tunnelled cuffed catheter removal. RESULTS There were no differences in clinical or demographic variables between the three subgroups. Biofilm thickness was lower in the taurolidine group than in the citrate 4% and heparin groups (28.85 ± 6.86 vs 49.99 ± 16.56 vs 56.2 ± 15.67 µm, respectively; p < 0.001), as was biofilm volume (1.01 ±1.18 vs 3.7 ± 2.15 vs 5.55 ±2.44, µm3, respectively; p < 0.001). The mean interleukin-6 value was 39%, which was 50% lower than in the citrate and heparin groups, but without significance differences. CONCLUSION Our results show that biofilms were found in all tunnelled cuffed catheters, but the thickness and volume were significantly lower in tunnelled cuffed catheters locked with taurolidine solution. Therefore, the type of locking solution used in tunnelled cuffed catheters should maintain tunnelled cuffed catheter sterility and prevent catheter-related bloodstream infections. No significant difference was observed in the inflammatory profile according to the type of locking solution.
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Affiliation(s)
- Mario Jiménez Hernández
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain.,School of Medicine, Universidad de las Americas Puebla, San Andrés Cholula, Puebla, Mexico
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Filella
- Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Calvo
- Advanced Optical Microscopy Unit, Scientific and Technological Centers of the University of Barcelona, Barcelona, Spain
| | - Elisenda Coll
- Advanced Optical Microscopy Unit, Scientific and Technological Centers of the University of Barcelona, Barcelona, Spain
| | - Josep M Rebled
- Unitat de Microscòpia Electrònica (TEM/SEM), Centres Científics i Tecnològics, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Fredzia Graterol
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Francisco Maduell
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Néstor Fontsere
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain.,Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Sun Y, Wan G, Liang L. Taurolidine lock solution for catheter-related bloodstream infections in pediatric patients: A meta-analysis. PLoS One 2020; 15:e0231110. [PMID: 32255798 PMCID: PMC7138323 DOI: 10.1371/journal.pone.0231110] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/16/2020] [Indexed: 12/15/2022] Open
Abstract
Infection is one of the most commonly described complications, and a major cause of morbidity and mortality in pediatric patients treated using central venous catheters (CVCs). Taurolidine lock solutions have been used to decrease catheter-related bloodstream infections (CRBSIs) in both adult and pediatric patients. The purpose of this study was to systematically search the literature and conduct a meta-analysis to determine the efficacy of taurolidine in reducing CRBSI in children. We conducted an electronic search of the PubMed, EMBASE, Cochrane Library, TRIP Database, CINAHL, and Google Scholar databases for articles published up to 1st November 2019. Eligible studies included randomized controlled trials (RCTs) comparing the effects of taurolidine with control for preventing CRBSI in pediatric patients. Four studies were included. Our results indicated a statistical significant reduction in the total number of CRBSI with taurolidine as compared to control (RR: 0.23; 95% CI:0.13, 0.40; I2 = 0%; P<0.00001). The pooled analysis also indicated a statistical significant reduction in the incidence of CRBSI (defined as the number of CRBSI events/1000 catheter days) in the taurolidine group (MD: -1.12; 95% CI:-1.54, -0.71; I2 = 1%; P<0.00001). The number of catheters removed due to infection or suspected infection was not significantly different between the two groups (RR: 0.68; 95% CI:0.22, 2.10; I2 = 56%; P = 0.50) (Fig 5). The quality of the included studies was not high. The use of taurolidine as a catheter locking solution may significantly reduce CRBSI in pediatric patients. However, the quality of current evidence is not high and further high-quality large scale RCTs are needed to corroborate our results.
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Affiliation(s)
- Yan Sun
- Zaozhuang Traditional Chinese Medicine Hospital, Zaozhuang, Shandong, P.R. China
| | - Guanghui Wan
- Zaozhuang Traditional Chinese Medicine Hospital, Zaozhuang, Shandong, P.R. China
| | - Liping Liang
- Zaozhuang Traditional Chinese Medicine Hospital, Zaozhuang, Shandong, P.R. China
- * E-mail:
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14
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Sheng KX, Zhang P, Li JW, Cheng J, He YC, Böhlke M, Chen JH. Comparative efficacy and safety of lock solutions for the prevention of catheter-related complications including infectious and bleeding events in adult haemodialysis patients: a systematic review and network meta-analysis. Clin Microbiol Infect 2019; 26:545-552. [PMID: 31857208 DOI: 10.1016/j.cmi.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/28/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Central venous catheters are used extensively as temporary or permanent vascular access for haemodialysis patients. Catheter-related bloodstream infections are the main complication of central venous catheters and increase morbidity and mortality in haemodialysis patients. OBJECTIVES The aim was to assess the most appropriate lock solution for central venous catheters to prevent catheter-related bloodstream infections and other complications. DATA SOURCES Medline, Embase and the Cochrane Central Register of Controlled Trials from the date of their inception to August 2018 were used as data sources. The reference lists of eligible studies and relevant reviews were also checked. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS Randomized controlled trials (RCTs) comparing different lock solutions for the prevention of central venous catheter-related infectious and bleeding complications for adult dialysis patients were included. INTERVENTIONS Interventions were lock solutions for haemodialysis catheters. METHODS The primary outcomes were catheter-related bloodstream infections and bleeding events. The secondary outcomes were catheter malfunction, exit-site infection, and all-cause mortality. We estimated summary risk ratios (RRs) using pairwise and network meta-analysis. We assessed the risk of bias of individual studies with the Cochrane risk of bias tool. RESULTS Forty-nine trials (7020 patients) were included for this study. Compared with heparin 5000 U/mL, antibiotic locks (antibiotics with trisodium citrate (TSC), ethylenediamine tetraacetic acid (EDTA), heparin 5000 U/mL, low-dose heparin or urokinase) and ethanol locks were more effective in preventing catheter-related bloodstream infections. Antimicrobial agents plus low-dose heparin (500-2500 U/mL), TSC and low-dose heparin locks had lower risk of bleeding events than heparin 5000 U/mL. None of the lock solutions reduced rates of catheter malfunction and all-cause mortality compared with heparin 5000 U/mL. In summary, antibiotics plus low-dose heparin was ranked as the best lock solution. The overall results were not materially changed in sensitivity analyses. CONCLUSIONS Taking into account both efficacy and safety, antibiotics plus low-dose heparin (500-2500 U/mL) may be the preferred lock solution.
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Affiliation(s)
- K X Sheng
- Kidney Disease Centre, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - P Zhang
- Kidney Disease Centre, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - J W Li
- Kidney Disease Centre, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - J Cheng
- Kidney Disease Centre, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Y C He
- Kidney Disease Centre, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - M Böhlke
- Dialysis and Kidney Transplantation Unit, São Francisco de Paula University Hospital, Postgraduate Programme in Health and Behaviour, Catholic University of Pelotas, Pelotas, Brazil
| | - J H Chen
- Kidney Disease Centre, First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China.
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15
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Fisher M, Golestaneh L, Allon M, Abreo K, Mokrzycki MH. Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis. Clin J Am Soc Nephrol 2019; 15:132-151. [PMID: 31806658 PMCID: PMC6946076 DOI: 10.2215/cjn.06820619] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the hemodialysis setting has been the focus of the Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Coalition and, more recently, the CDC's partnership with the American Society of Nephrology's Nephrologists Transforming Dialysis Safety Initiative. The majority of vascular access-associated bloodstream infections occur in patients dialyzing with central vein catheters. The CDC's core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection. However, in the United States hemodialysis catheter-associated bloodstream infections continue to occur at unacceptable rates, possibly because of lapses in adherence to strict aseptic technique, or additional factors not addressed by the CDC's core interventions. There is a clear need for novel prophylactic therapies. This review highlights the recent advances and includes a discussion about the potential limitations and adverse effects associated with each option.
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Affiliation(s)
- Molly Fisher
- Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ladan Golestaneh
- Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Kenneth Abreo
- Division of Nephrology, Louisiana State University Health at Shreveport, Shreveport, Louisiana
| | - Michele H Mokrzycki
- Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York;
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Abstract
PURPOSE OF REVIEW Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates. RECENT FINDINGS Many innovations in dialysis catheters have been proposed by the industry over the past decade, including the material used, the shape of the lumens and the position of the inflow and outflow holes. Impregnated catheters have also been developed to prevent catheter-related infections. Many locking solutions are available, either for maintaining catheter patency or for preventing infections. SUMMARY Although studies conducted in the specific context of the ICU are still scarce, some conclusions can be drawn. Catheter length must be adapted to the insertion site to reach an area of high blood flow. Kidney-shape lumens appear to be less thrombogenic and seem to prevent catheter dysfunction. Catheter tip and lumen holes also affect catheter function. For catheter locking, 4% citrate appears nowadays as one of the best options, but taurolidine-based solutions are also interesting.
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Tu MM, Xu JJ, Qiu YR. Surface hemocompatible modification of polysulfone membrane via covalently grafting acrylic acid and sulfonated hydroxypropyl chitosan. RSC Adv 2019; 9:6254-6266. [PMID: 35517280 PMCID: PMC9062722 DOI: 10.1039/c8ra10573a] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/05/2019] [Indexed: 12/29/2022] Open
Abstract
In this study, acrylic acid (AA) and sulfonated hydroxypropyl chitosan (SHPCS) were covalently grafted on the PSf membrane surface to improve its hemocompatibility.
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Affiliation(s)
- Ming-Ming Tu
- College of Chemistry and Chemical Engineering
- Central South University
- Changsha 410083
- PR China
| | - Jing-Jie Xu
- College of Chemistry and Chemical Engineering
- Central South University
- Changsha 410083
- PR China
| | - Yun-Ren Qiu
- College of Chemistry and Chemical Engineering
- Central South University
- Changsha 410083
- PR China
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18
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Sherman RA. Briefly Noted. Semin Dial 2018. [DOI: 10.1111/sdi.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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