Does the Heparin Lock Concentration Affect Hemodialysis Catheter Patency?

Abstract

Background and objectives: Concentrated heparin solutions are instilled into the catheter lumens after each hemodialysis session to prevent catheter thrombosis. The heparin lock concentration at many centers has been decreased recently to reduce the risk of systemic bleeding and contain costs. However, the effect of this change on catheter patency is unknown. We compared catheter patency between two heparin lock solutions: 1000 versus 5000 units/ml. Design, setting, participants, & measurements: With use of a prospective, computerized, vascular access database, 105 patients with newly placed tunneled hemodialysis catheters, including 58 patients receiving a 5000 units/ml heparin lock and 47 patients receiving a 1000 units/ml heparin lock, were retrospectively identified. The primary endpoint was cumulative catheter patency and the secondary endpoint was frequency of thrombolytic instillation.Results: Cumulative catheter survival was similar in the two groups, being 71% versus 73% at 120 days in the low-and high-concentration heparin lock groups (hazard ratio of catheter failure, 0.97; 95% confidence interval, 0.45 to 2.09; P ‫؍‬ 0.95). The frequency of tissue plasminogen activator instillation was significantly greater in the low-concentration heparin group (hazard ratio, 2.18; 95% CI, 1.26 to 3.86; P ‫؍‬ 0.005). No major bleeding complications were observed in either treatment group. The overall drug cost for maintaining catheter patency was 23% lower with the low-concentration heparin lock ($1418 versus $1917) to maintain catheter patency for 1000 days.Conclusions: Low-concentration heparin lock solutions do not decrease cumulative dialysis catheter patency, but require a twofold increase in thrombolytic instillation to maintain long-term patency.

Improved Hemocompatibility of Multilumen Catheters via Nitric Oxide (NO) Release from S-Nitroso-N-acetylpenicillamine (SNAP) Composite Filled Lumen

“…10 In clinical practice, anticoagulant (e.g., heparin, citrate) and antibiotic lock solutions are also used. 1, 11–12 Lock solutions containing anticoagulants are employed to prevent local thrombus formation, but have had similar rates of thrombosis and fail to address issues related to microbial infection. 11, 13 Catheter replacement is the only solution in many cases, which can further increase chances of infection.…”

“…1, 11–12 Lock solutions containing anticoagulants are employed to prevent local thrombus formation, but have had similar rates of thrombosis and fail to address issues related to microbial infection. 11, 13 Catheter replacement is the only solution in many cases, which can further increase chances of infection. 14–15 Development of polymers that can resist both thrombosis and infection is still a prominent area of research with the potential for significant clinical benefits.…”

Interventional Nephrology

“…In various other protocols, investigators compared the effectiveness of different heparin concentrations (5000 or 10,000 units/ml versus 1000 units/ml) in maintaining catheter patency. Although the incidence of catheter malfunction did not change with the lower dose of heparin as a prophylactic locking solution, the use of tPA to maintain patency increased significantly (25)(26)(27).…”

Acesso vascular para hemodialise: o que ha de novo?

“…Thomson et al 21 report that using 1000 UI/mL heparin involves reduced risk of systemic heparinization than the usual 5000 UI/ mL dosage, without increasing rates of infection, catheter loss or malfunction. However, Ivan et al 22 used the same concentrations of heparin and showed that although catheter patencies were similar in both groups, the group given 1000 UI/mL needed twice the volume of thrombolytics infused to deobstruct catheters. At our department, routine procedure is to fill catheters with heparin 5000 UI/mL.…”