Sungur Murat, Eryuksel Emel, Yavas Sinan, Bihorac Azra, Layon A Joseph, Caruso Lawrence
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA.
Nephrol Dial Transplant. 2007 Dec;22(12):3533-7. doi: 10.1093/ndt/gfm452. Epub 2007 Sep 26.
Double lumen dialysis catheters are routinely heparin or citrate 'locked' to maintain patency. Heparin lock-related bleeding episodes and antibiotic lock-related toxicity have been reported. The aim of this study is to quantify the amount of leak during 'lock' procedures and to compare leakage for different double lumen dialysis catheters.
In an experimental, in vitro study at a University research laboratory, five different double lumen dialysis catheters were tested using three different lock volumes.
Using the catheter flush volume, leak ratios for Flexxicon II 15 cm and 20 cm catheters were greater than that seen in the Arrow 16 cm catheter (P < 0.05). Using 20% less than the catheter flush volume, the Flexxicon II 20 cm catheter had greater leak than the Duo-flow 15 and 20 cm catheters and Arrow 16 cm catheter (P < 0.05). The Flexxicon II 15 cm catheter had greater leak than the Duo-flow 15 cm and Duo-flow 20 cm catheters with 20% less locking volume (P < 0.05). Using 20% greater than the catheter flush volume, the Duo-flow 20 cm catheter had significantly less leak ratio than the Flexxicon II 20 cm catheter (P < 0.05). There were no other significant differences in leak ratios between the catheters.
All double lumen dialysis catheters we tested have a substantial amount of leak even when the catheter 'lock' volumes were used, and leak ratio increases significantly with 20% overfill. There is a leak even when using 20% less 'lock' volume. The amount of leak can be clinically important and may explain the reports of bleeding episodes after heparin lock and antibiotic toxicity after antibiotic and anticoagulant combination lock. Some devices have lower leak ratios than others, likely related to catheter design.
双腔透析导管通常用肝素或枸橼酸盐“封管”以保持通畅。已有肝素封管相关出血事件及抗生素封管相关毒性的报道。本研究的目的是量化“封管”过程中的漏液量，并比较不同双腔透析导管的漏液情况。
在一所大学研究实验室进行的一项体外实验研究中，使用三种不同的封管容积对五种不同的双腔透析导管进行了测试。
以导管冲洗容积计算，Flexxicon II 15 cm和20 cm导管的漏液率高于Arrow 16 cm导管（P<0.05）。当封管容积比导管冲洗容积少20%时，Flexxicon II 20 cm导管的漏液比Duo-flow 15 cm和20 cm导管以及Arrow 16 cm导管更多（P<0.05）。当封管容积比导管冲洗容积少20%时，Flexxicon II 15 cm导管的漏液比Duo-flow 15 cm和Duo-flow 20 cm导管更多（P<0.05）。当封管容积比导管冲洗容积多20%时，Duo-flow 20 cm导管的漏液率显著低于Flexxicon II 20 cm导管（P<0.05）。各导管之间的漏液率无其他显著差异。
我们测试的所有双腔透析导管即使在使用导管“封管”容积时也存在大量漏液，且当封管容积超量20%时漏液率会显著增加。即使封管容积减少20%仍会有漏液。漏液量在临床上可能很重要，这或许可以解释肝素封管后出血事件的报道以及抗生素与抗凝剂联合封管后抗生素毒性的报道。一些装置的漏液率低于其他装置，这可能与导管设计有关。
