The impact of catheter-restricted filling with cefotaxime and heparin on the lifespan of temporary hemodialysis catheters: a case controlled study.
BACKGROUND
Reduction in the rates of major complications such as infection and thrombosis that limit the lifespan of hemodialysis (HD) catheters could conceivably lead to improved survival of "temporary" non-tunneled HD catheters (NTCs). This study was designed to evaluate the impact of the "locking"' of a broad-spectrum antibiotic-cefotaxime with heparin, on the incidence of catheter thrombosis, catheter-related bloodstream infections (CRBSI) and the NTC lifespan.


METHODS
This prospective study included 208 (109 males and 99 females) end-stage renal disease (ESRD) patients of diverse etiology enrolled for long-term HD from July 2002 to June 2003 at our tertiary care hospital. Those patients requiring NTC insertion for the maintenance or commencement of HD were eligible for the study. Cefotaxime-heparin "lock" solutions were freshly prepared by dissolving sterile cefotaxime sodium powder for injection directly in the heparin sodium to reach a concentration of 10 mg/mL for cefotaxime and 5000 U/mL for heparin. A final volume of 5 mL was prepared in a syringe using aseptic precautions to fill 1.3 mL in the venous and 1.2 mL in the arterial lumen of the catheter with a combined volume of approximately 2.5 mL. Blood samples were collected for culture and sensitivity, simultaneously, from the catheter hub and the peripheral vein, on clinical suspicion of CRBSI. Thrombosis was defined as the inability to use the catheter at a blood flow of 200 ml/min, which did not respond to catheter repositioning and/or intraluminal thrombolysis.


RESULTS
An overall relative risk reduction (RRR) of 56.5% for catheter thrombosis and separately for all types of NTCs (femoral (FC) - 52.7%, subclavian (SC) - 55.9%, and internal jugular (IJC) - 53.7%), were observed in group II having a cefotaxime-heparin lock solution. A lower CRBSI incidence (1.65 vs. 3.13/1000 catheter days) compared with group I, leading to a RRR of 50.5% was also recorded in group II. Significantly higher percentage catheter survival rates at 7, 14 and at 28 days for FC and at 14, 28 and 56 days for SC and IJC were observed among patients in group II in comparison to group I.


CONCLUSIONS
Cefotaxime-heparin locks led to a significant reduction in catheter thrombosis and CRBSI incidence. The enhanced NTC lifespan thus achieved could help physicians in better assessment of the patient's vasculature prior to the placement of permanent vascular access.
Saxena
Anil K
AK
Division of Nephrology, Post-graduate Department of Medicine, King Fahad Hospital and Tertiary Care Center, King Faisal University, Eastern Province - Saudi Arabia. dranil_31982@yahoo.com
Panhotra
Bodh R
BR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016022:Case-Control Studies; D002408:Catheters, Indwelling / Q000009:adverse effects; D002439:Cefotaxime / Q000627:therapeutic use*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006493:Heparin; D002439:Cefotaxime