Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. Activated partial thromboplastin time (APTT) was measured prior to, and three minutes after, heparin locking of catheter lumens with the manufacturer's recommended locking volume to assess the effect on systemic anticoagulation. Heparin locking of venous dialysis catheters resulted in a significant rise in APTT (P=0.002). The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety.

Traditionally heparin has been the anticoagulant of choice for venous dialysis catheter locking. There is systemic leakage of heparin catheter locking solutions at the time of injection. Alternative agents, such as citrate, are increasingly being used. We are not aware of any data in the critical care literature on the effect of citrate locking of venous dialysis catheters on systemic ionised calcium (iCa 2+). To assess the effect of 4% citrate locking of venous dialysis catheters on systemic iCa 2+ in intensive care patients we performed a prospective observational study of 50 paired samples in 26 intensive care patients receiving 4% citrate dialysis catheter locking in an adult tertiary intensive care unit between May 2016 and December 2016. Arterial blood gas (ABG) analysis was performed prior to venous dialysis catheter locking and a baseline iCa 2+ result obtained. The catheter was locked with 4% citrate solution. A further ABG was sampled between 30 and 120 seconds later and the iCa 2+ results were compared. Patients were observed for clinical signs of hypocalcaemia. On average, there was little difference between the pre-and post-catheter locking iCa 2+ (median pre-locking iCa 2+ 1.19 mmol/l, mean change of +0.004 mmol/l, 95% confidence interval [CI]-0.004 to 0.013, P=0.34). There was no evidence this difference differed by length of catheter (P=0.26) or site of catheter (P=0.85) insertion, but there was some evidence that this differed by receipt of citrate dialysis circuit anticoagulation (P=0.013). Patients who received citrate dialysis circuit anticoagulation had an increase in catheter locking iCa 2+ by 0.017 mmol/l (95% CI 0.005 to 0.028). Locking of venous dialysis catheters with 4% citrate solution has no clinically significant effect on systemic iCa 2+ in intensive care patients with indwelling venous dialysis catheters.

Objective: This study aimed to evaluate the efficacy of Centella asiatica leaf extract in maintaining calcium and phosphate levels in the bone forpreventing osteoporosis in postmenopausal women.Methods: The obtained C. asiatica leaf extract was administered to ovariectomized rats at the doses of 60, 120, and 180 mg/kg body weight (BW)for 30 days. Subsequently, the rats were euthanized by ether overdose, and bone calcium and phosphate levels were determined by the wet ashingtechnique and spectrophotometry.Results: The results showed no significant differences in the bone calcium and phosphate levels among rats administered with different doses ofC. asiatica leaf extract.Conclusion: Our results indicate that C. asiatica leaf extract cannot be used as a source of phytoestrogens to maintain calcium and phosphate levelsin the bones.