Concentration of heparin-locking solution and risk of central venous hemodialysis catheter malfunction.
Heparin is used as an interdialytic locking solution for hemodialysis (HD) central venous catheters (CVCs). The purpose of this study was to compare effectiveness of two heparin concentrations (10,000 and 1,000 U/mL) in preventing catheter malfunction. We compared two time periods: a 6-month period with heparin 10,000 U/mL and a 3-month period with heparin 1,000 U/mL. Adults on HD using a CVC (tunneled or untunneled) in Calgary, Alberta, were included. The primary outcome was catheter malfunction. A total of 139 and 134 patients in the heparin 10,000 and 1,000 U/mL periods, respectively, were included. The crude rate of catheter malfunction, per 1,000 HD sessions, was similar for heparin 10,000 (7.6; 95% CI, 5.3 to 10.8) and 1,000 (6.7; 95% CI, 4.3 to 10.3) U/mL periods, respectively (p = 0.76). After adjusting for CVC characteristics and use of recombinant tissue plasminogen activator (rt-PA), there was no association between heparin concentration and CVC malfunction (hazard ratio, 0.77; 95% CI, 0.37 to 1.61). In conclusion, the use of a lower concentration of heparin was not associated with an increased risk of catheter malfunction but may be associated with greater rt-PA use. The association between heparin concentration and rt-PA use requires further study.
Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
Chandra M
CM
Thomas
Jianguo
J
Zhang
Teik How
TH
Lim
Nairne
N
Scott-Douglas
Ronald B
RB
Hons
Brenda R
BR
Hemmelgarn
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D006435:Renal Dialysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012996:Solutions; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D012996:Solutions; D006493:Heparin; D010959:Tissue Plasminogen Activator