title: Comparison of intensive versus standard hemodialysis central venous catheter dysfunction protocol using rt-PA: a quality assurance initiative.
abstract: OBJECTIVE
  Catheter locking solutions such as recombinant tissue plasminogen activator (rt-PA) are used to treat and prevent clotting of hemodialysis (HD) catheters during HD treatments and the interdialytic period. However, evidence to guide the use of rt-PA for catheter dysfunction is limited.
  
  
  METHODS
  We evaluated outcomes using two catheter dysfunction protocols in a cohort of consecutive prevalent dialysis patients (Jan 2013 to Sep 2014) undergoing HD with a tunneled catheter. In the intensive protocol, rt-PA was administered to all catheters based on blood flow and/or line reversal. In the standard protocol, rt-PA administration was based only on blood flow. The primary outcome was the rate of rt-PA use for catheter malfunction (rt-PA treatment days/1000 total line days; [TLD]). Secondary outcomes included the cost of rt-PA/TLD and the rate of catheter-related bacteremia.
  
  
  RESULTS
  There were 26 and 35 patients managed by the intensive and standard protocols, respectively. The rate of rt-PA use was 52/1000 TLD (intensive) versus 39/1000 TLD (standard) (rate ratio 1.30, 95% CI 1.12-1.52 CI, p&lt;0.001). The rate of bacteremia was 0.43 and 0.22/1000 TLD for the intensive and standard protocols, respectively (p = 0.491). The cost of rt-PA was CDN $5.58 and CDN $6.15 per TLD for the intensive protocol and standard protocol groups (p&lt;0.001).
  
  
  CONCLUSIONS
  Managing catheter dysfunction based on line reversal and blood flow as opposed to only blood flow was associated with a higher rate of rt-PA use, but at a reduced overall cost.
authors: Division of Nephrology, Department of Medicine, Nova Scotia Health Authority Central Zone, Halifax, Nova Scotia - Canada.|College of Pharmacy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia - Canada.
authors: Jo-Anne S
authors: JA
authors: Wilson
authors: Nova Scotia Health Authority Central Zone Renal Program, Halifax, Nova Scotia - Canada.
authors: Paula
authors: P
authors: Mossop
authors: Division of Nephrology, Department of Medicine, Nova Scotia Health Authority Central Zone, Halifax, Nova Scotia - Canada.|Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia - Canada.
authors: Steven D
authors: SD
authors: Soroka
authors: Division of Nephrology, Department of Medicine, Nova Scotia Health Authority Central Zone, Halifax, Nova Scotia - Canada.|Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia - Canada.
authors: Christine
authors: C
authors: Dipchand
authors: Nova Scotia Health Authority Central Zone Renal Program, Halifax, Nova Scotia - Canada.
authors: Sarah
authors: S
authors: Drost
authors: Nova Scotia Health Authority Central Zone Renal Program, Halifax, Nova Scotia - Canada.
authors: Niall
authors: N
authors: Sheehy
authors: Division of Nephrology, Department of Medicine, Nova Scotia Health Authority Central Zone, Halifax, Nova Scotia - Canada.|Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia - Canada.
authors: Karthik
authors: K
authors: Tennankore
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000191:economics; D062905:Central Venous Catheters / Q000191:economics; D002985:Clinical Protocols / Q000592:standards; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004867:Equipment Design; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000191:economics / Q000592:standards*; D011994:Recombinant Proteins / Q000008:administration & dosage; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000191:economics / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator