Beigi Ali Akbar, HadiZadeh Mirhadi Seyed, Salimi Fereshteh, Ghaheri Hafez
Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2014 May 28;3:121. doi: 10.4103/2277-9175.133192. eCollection 2014.
Heparin has long been used to prevent thrombosis in the permanent central venous hemodialysis catheters (PermCath). Other alternatives for heparin with fewer side-effects have recently been considered. We compared normal saline (0.9%) with heparin for flushing PermCath with regards to catheter patency and prevention of heparin complications.
Chronic kidney disease patients who were candidate of PermCath placement were randomly assigned into two groups of heparin and saline. In the heparin group, the PermCath was flushed with heparin (1000 IU), and in the saline group, it was flushed with saline 0.9%. Patients were followed for 24 hours, and outcomes included catheter thrombosis, maneuver needed to maintain catheter patency, and bleeding from catheter site.
Ninety six patients were included (age = 63.1 ± 11.2 years, 54.2% male). No one experienced catheter thrombosis. Two patient (4.2%) in the heparin and three ones (6.1%) in the saline group required catheter manipulation (P = 0.520). Four patients (8.5%) in the heparin and three ones (6.1%) in the saline group experienced bleeding (P = 0.476); differences between heparin and saline groups in the amount of bleeding (225.0 ± 62.4 vs. 200.0 ± 113.5 cc, P = 0.721) and bleeding time (6.5 ± 1.2 vs. 5.3 ± 1.5 min, P = 0.322) were not significant. In the heparin group, no significant increase was observed in PTT over time; baseline 30.9 ± 3.4, 12 h 31.8 ± 3.4, 24 h 31.2 ± 6.6 (P = 0.628).
Flushing PermCath with normal saline 0.9% is as effective as heparin in maintaining patency of the catheter, while it may reduce the risks associated with heparin.
长期以来，肝素一直用于预防永久性中心静脉血液透析导管（PermCath）内血栓形成。最近，人们开始考虑使用其他副作用较少的肝素替代品。我们比较了生理盐水（0.9%）和肝素冲洗PermCath在导管通畅性及预防肝素相关并发症方面的效果。
将有PermCath置入指征的慢性肾脏病患者随机分为肝素组和生理盐水组。肝素组用肝素（1000 IU）冲洗PermCath，生理盐水组用0.9%生理盐水冲洗。对患者进行24小时随访，观察指标包括导管血栓形成、维持导管通畅所需的操作以及导管部位出血情况。
共纳入96例患者（年龄=63.1±11.2岁，男性占54.2%）。无一例发生导管血栓形成。肝素组有2例患者（4.2%）、生理盐水组有3例患者（6.1%）需要进行导管操作（P=0.520）。肝素组有4例患者（8.5%）、生理盐水组有3例患者（6.1%）出现出血（P=0.476）；肝素组和生理盐水组在出血量（225.0±62.4 vs. 200.0±113.5 cc，P=0.721）和出血时间（6.5±1.2 vs. 5.3±1.5分钟，P=0.322）方面的差异无统计学意义。在肝素组，随时间推移活化部分凝血活酶时间（PTT）无显著升高；基线时为30.9±3.4，12小时时为31.8±3.4，24小时时为31.2±6.6（P=0.628）。
用0.9%生理盐水冲洗PermCath在维持导管通畅方面与肝素效果相同，同时可能降低与肝素相关的风险。
