BACKGROUND: Although most catheter problems in haemodialysis are related to infection or clotting, bleeding associated with the heparin lock is of clinical importance especially during peri-operative conditions. The objective of this in vitro study is to estimate the volume of heparin that may leak into the circulation immediately after performing a catheter lock. METHODS: Different volumes (ml) of a dextrose solution were used to perform a catheter lock on haemodialysis catheters. The tip of the catheter was placed in a test tube containing water for a pre-specified period. The final concentrations of dextrose in the test tube were used to determine the volume of solution that leaked from the catheter. RESULTS: When the total lumen volume was filled, the catheter leak was estimated to be 0.59+/-0.03 and 0.71+/-0.04 ml after 15 and 25 s, respectively. There was a continuous leak of 1.23+/-0.41, 2.20+/-0.34 and 3.38+/-0.23 ml at 5, 15 and 30 min, respectively, after performing a catheter lock on a catheter with a total lumen volume of 4.5 ml. The catheter leak was significantly reduced when only 3.7 ml of solution was used to fill the total lumen volume of 4.5 ml. CONCLUSION: The present study demonstrates a significant early and late leakage from the catheter that occurs after performing a catheter lock. When applied to heparin, the volume of the unwanted catheter leak may result in adverse clinical events, especially following haemodialysis sessions and during peri-operative periods. However, these results are hypothesis-generating, and clinical studies are necessary to evaluate the efficacy of underfilling.
BACKGROUND: Although most catheter problems in haemodialysis are related to infection or clotting, bleeding associated with the heparin lock is of clinical importance especially during peri-operative conditions. The objective of this in vitro study is to estimate the volume of heparin that may leak into the circulation immediately after performing a catheter lock. METHODS: Different volumes (ml) of a dextrose solution were used to perform a catheter lock on haemodialysis catheters. The tip of the catheter was placed in a test tube containing water for a pre-specified period. The final concentrations of dextrose in the test tube were used to determine the volume of solution that leaked from the catheter. RESULTS: When the total lumen volume was filled, the catheter leak was estimated to be 0.59+/-0.03 and 0.71+/-0.04 ml after 15 and 25 s, respectively. There was a continuous leak of 1.23+/-0.41, 2.20+/-0.34 and 3.38+/-0.23 ml at 5, 15 and 30 min, respectively, after performing a catheter lock on a catheter with a total lumen volume of 4.5 ml. The catheter leak was significantly reduced when only 3.7 ml of solution was used to fill the total lumen volume of 4.5 ml. CONCLUSION: The present study demonstrates a significant early and late leakage from the catheter that occurs after performing a catheter lock. When applied to heparin, the volume of the unwanted catheter leak may result in adverse clinical events, especially following haemodialysis sessions and during peri-operative periods. However, these results are hypothesis-generating, and clinical studies are necessary to evaluate the efficacy of underfilling.
Authors: Steven M Brunelli; Dena E Cohen; Gilbert Marlowe; Daniel Liu; Levi Njord; David Van Wyck; George Aronoff Journal: J Nephrol Date: 2019-01-02 Impact factor: 3.902
Authors: Michael C Barbour; Patrick M McGah; Chin H Ng; Alicia M Clark; Kenneth W Gow; Alberto Aliseda Journal: ASAIO J Date: 2015 Nov-Dec Impact factor: 2.872
Authors: Riad Rahhal; Maisam A Abu-El-Haija; Lin Fei; Dawn Ebach; Sarah Orkin; Elizabeth Kiscaden; Conrad R Cole Journal: JPEN J Parenter Enteral Nutr Date: 2017-12-19 Impact factor: 4.016
Authors: Gernot Schilcher; Axel Schlagenhauf; Daniel Schneditz; Hubert Scharnagl; Werner Ribitsch; Robert Krause; Alexander R Rosenkranz; Tatjana Stojakovic; Joerg H Horina Journal: PLoS One Date: 2013-12-31 Impact factor: 3.240