Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon.
EA 7426 'Pathophysiology of Injury-Induced Immunosuppression' - PI3, Hospices Civils de Lyon - Biomérieux - University Claude Bernard Lyon 1, Lyon, France.
Curr Opin Crit Care. 2018 Dec;24(6):469-475. doi: 10.1097/MCC.0000000000000543.
Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates.
Many innovations in dialysis catheters have been proposed by the industry over the past decade, including the material used, the shape of the lumens and the position of the inflow and outflow holes. Impregnated catheters have also been developed to prevent catheter-related infections. Many locking solutions are available, either for maintaining catheter patency or for preventing infections.
Although studies conducted in the specific context of the ICU are still scarce, some conclusions can be drawn. Catheter length must be adapted to the insertion site to reach an area of high blood flow. Kidney-shape lumens appear to be less thrombogenic and seem to prevent catheter dysfunction. Catheter tip and lumen holes also affect catheter function. For catheter locking, 4% citrate appears nowadays as one of the best options, but taurolidine-based solutions are also interesting.
为肾替代治疗（RRT）选择最佳的导管并非易事。除了导管的长度，其许多特性也会影响 RRT 治疗的效果。导管的维护，特别是封管液，也会影响导管的使用寿命和感染率。
在过去十年中，行业提出了许多关于透析导管的创新，包括所用材料、管腔的形状以及进出水口的位置。为了预防导管相关性感染，还开发了浸渍导管。有许多种封管液可供选择，无论是为了保持导管通畅还是预防感染。
尽管 ICU 特定环境下的研究仍然很少，但仍可以得出一些结论。导管的长度必须根据插入部位进行调整，以到达血流丰富的区域。肾形管腔似乎不易形成血栓，并且似乎可以防止导管功能障碍。导管尖端和管腔孔也会影响导管的功能。对于导管封管，目前 4%柠檬酸盐似乎是最佳选择之一，但基于牛磺罗定的溶液也很有意义。
