Heparin leak from a hemodialysis catheter causing major bleeding, ultimately leading to transplant rejection and death

Dreyer, Gavin; Lawton, Paul; Jose, Matthew

doi:10.1111/j.1542-4758.2008.00306.x

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…Heparin concentrations used for locking hemodialysis catheters have ranged from 1000 to 10,000 units per mL with the assumption that higher concentrations will decrease proportionally the risk of catheter thrombosis. High concentration heparin however, was also found to cause an elevated systemic activated partial thromboplastin time (APTT) and was linked with increased risk of bleeding, infection and increased cost . Chronic kidney disease (CKD) is already an independent risk factor for bleeding; so it is important to ensure dialysis patients’ exposure to inappropriate anticoagulation is minimised.…”

Section: Introductionmentioning

confidence: 99%

Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial

Chu

Fogarty

Avis

et al. 2016

Hemodialysis International

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Introduction Heparin is commonly used after hemodialysis treatments as a locking solution to prevent catheter thrombosis. The comparative efficacy and safety of different heparin concentrations to maintain catheter patency has been previously reported in retrospective studies. We conducted a prospective, randomised, controlled study of 1000 U/mL heparin (low dose) versus 5000 U/mL heparin (high dose) locking solution to maintain patency of tunnelled catheters. Methods One hundred patients receiving chronic, unit-based hemodialysis with newly placed tunnelled hemodialysis catheters (less than 1 week) were randomly assigned to either a low dose (n = 48) or high dose heparin (n=52). The primary intention-to-treat analysis examined time to malfunction in both groups over a 90 day period. A secondary analysis compared baseline patient characteristics in relation to catheter malfunction. Findings Overall rate of catheter patency loss was 32% of catheters by 90 days. There was no significant difference in time to malfunction of catheters locked with low dose or high dose heparin (P = 0.5770). Time to catheter malfunction was not associated with diabetic, hypertensive or smoking status. There was no difference in mean delivered blood flow rate, venous and arterial pressure, and dialysis adequacy between low dose and high dose groups. No patient suffered a hemorrhagic complication requiring hospitalisation during the study period. Discussion Low dose heparin is adequate to maintain tunnelled hemodialysis catheter patency when compared with high dose heparin. The study also suggests that there is no relationship between catheter malfunction and diabetic, hypertensive or smoking status.

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Section: Introductionmentioning

confidence: 99%

Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial

Chu

Fogarty

Avis

et al. 2016

Hemodialysis International

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“…It is likely that in a real situation in which the catheter is placed in a central vein none of the two cases treated above describes the true conditions around the tip hole. It is known that catheter filled with anticoagulating agents (lock solution) drips slowly between catheter usage and parts of the lock solution in the distal end therefore leaks to the bloodstream (24,25). If there is a small flow of UVC transparent liquid into the bloodstream (as for the lock solutions) during the intraluminal treatment time the situation outside the catheter tip could become more complicated (mixture zone blood/saline solution).…”

Section: Resultsmentioning

confidence: 99%

Potential In Vivo UVC Disinfection of Catheter Lumens: Estimation of the Doses Received by the Blood Flow Outside the Catheter Tip Hole

Bak

Jørgensen

Helfmann

et al. 2011

Photochem & Photobiology

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We have demonstrated that it is possible to launch UVC LED light into bacterial contaminated polymer tubes/catheters and disinfect the intraluminal space of these tubes. This can be achieved by UVC treatment of the catheters on a regular basis. Catheters are in the distal end equipped with an exit hole for administration of drugs, bloods or nutrients into the bloodstream. Even if the UVC light is strongly attenuated during its propagation through the catheter tube a fraction of the UVC launched into the catheter will escape through the exit hole and irradiate the blood. We demonstrate by calculations that very small effective doses are exposed to the blood (ca 10(-4) J m(-2)). This dosage level is very low compared with UVC doses reported from other therapeutic applications. The very short residence time of the blood constituents in the irradiated volume in front of the exit hole is the main reason why the UVC exposure to the blood in the catheter application is so low. The very low dose received by the blood through the catheter tip indicated that possible side effects are negligible and makes the UV disinfection technique feasible in a clinical setting.

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“…Heparin leak into the systemic circulation may cause heparin-induced thrombocytopenia and increase the risk of systemic coagulopathy and bleeding. [567]…”

Section: Introductionmentioning

confidence: 99%

Heparin compared with normal saline to maintain patency of permanent double lumen hemodialysis catheters: A randomized controlled trial

et al. 2014

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Background:Heparin has long been used to prevent thrombosis in the permanent central venous hemodialysis catheters (PermCath). Other alternatives for heparin with fewer side-effects have recently been considered. We compared normal saline (0.9%) with heparin for flushing PermCath with regards to catheter patency and prevention of heparin complications.Materials and Methods:Chronic kidney disease patients who were candidate of PermCath placement were randomly assigned into two groups of heparin and saline. In the heparin group, the PermCath was flushed with heparin (1000 IU), and in the saline group, it was flushed with saline 0.9%. Patients were followed for 24 hours, and outcomes included catheter thrombosis, maneuver needed to maintain catheter patency, and bleeding from catheter site.Results:Ninety six patients were included (age = 63.1 ± 11.2 years, 54.2% male). No one experienced catheter thrombosis. Two patient (4.2%) in the heparin and three ones (6.1%) in the saline group required catheter manipulation (P = 0.520). Four patients (8.5%) in the heparin and three ones (6.1%) in the saline group experienced bleeding (P = 0.476); differences between heparin and saline groups in the amount of bleeding (225.0 ± 62.4 vs. 200.0 ± 113.5 cc, P = 0.721) and bleeding time (6.5 ± 1.2 vs. 5.3 ± 1.5 min, P = 0.322) were not significant. In the heparin group, no significant increase was observed in PTT over time; baseline 30.9 ± 3.4, 12 h 31.8 ± 3.4, 24 h 31.2 ± 6.6 (P = 0.628).Conclusions:Flushing PermCath with normal saline 0.9% is as effective as heparin in maintaining patency of the catheter, while it may reduce the risks associated with heparin.

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Heparin leak from a hemodialysis catheter causing major bleeding, ultimately leading to transplant rejection and death

Cited by 5 publications

References 8 publications

Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial

Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial

Potential In Vivo UVC Disinfection of Catheter Lumens: Estimation of the Doses Received by the Blood Flow Outside the Catheter Tip Hole

Heparin compared with normal saline to maintain patency of permanent double lumen hemodialysis catheters: A randomized controlled trial

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