Wilson Jo-Anne S, Mossop Paula, Soroka Steven D, Dipchand Christine, Drost Sarah, Sheehy Niall, Tennankore Karthik
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.
J Vasc Access. 2016 Mar-Apr;17(2):143-50. doi: 10.5301/jva.5000501. Epub 2016 Feb 5.
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.
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.
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<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<0.001).
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.
诸如重组组织型纤溶酶原激活剂（rt-PA）之类的导管封管溶液用于在血液透析（HD）治疗期间及透析间期治疗和预防HD导管凝血。然而，指导使用rt-PA治疗导管功能障碍的证据有限。
我们在一组连续的接受隧道式导管HD治疗的透析患者（2013年1月至2014年9月）中，使用两种导管功能障碍方案评估结果。在强化方案中，根据血流量和/或管路反流情况，对所有导管使用rt-PA。在标准方案中，仅根据血流量使用rt-PA。主要结局是rt-PA用于导管故障的使用率（rt-PA治疗天数/1000总管路天数；[TLD]）。次要结局包括rt-PA/TLD的成本以及导管相关菌血症的发生率。
分别有26例和35例患者采用强化方案和标准方案进行治疗。rt-PA使用率为52/1000 TLD（强化方案）对39/1000 TLD（标准方案）（率比1.30，95%CI 1.12-1.52，p<0.001）。强化方案和标准方案的菌血症发生率分别为0.43和0.22/1000 TLD（p = 0.491）。强化方案组和标准方案组rt-PA的成本分别为每TLD 5.58加元和6.15加元（p<0.001）。
基于管路反流和血流量而非仅血流量来处理导管功能障碍，与较高的rt-PA使用率相关，但总成本降低。
