Mathur Gagan, Mott Sarah L, Collins Laura, Schlueter Annette J
Department of Pathology, Saint Luke's Health System, Kansas City, Missouri.
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.
J Clin Apher. 2019 Aug;34(4):445-449. doi: 10.1002/jca.21697. Epub 2019 Mar 4.
Central venous catheters (CVCs) for apheresis procedures require regular locking/flushes to maintain adequate flow rates. Literature comparing locking solutions for apheresis, where the time interval between procedures can be longer than for hemodialysis (many days to weeks), is lacking. In this study, catheter malfunction rates using recombinant tissue plasminogen activator (rt-PA) vs heparin for locking CVC between apheresis procedures were compared.
A retrospective review of 93 extracorporeal photopheresis procedures in 10 patients was performed at our institution. About 1000 U/mL heparin or 2 mg rt-PA was used as the locking solution. Heparin locks were changed at least once per week and rt-PA locks could be left in place for up to 4 weeks. Following these locks, inadequate blood flow noted on accessing CVC and/or during the procedure was scored on as: no issues, some issues, or significant issues. Binary logistic regression was used to evaluate for potential statistical difference in outcomes. Cost analysis was also performed.
No statistically significant difference was noted in outcomes between heparin and rt-PA lock (P value = 0.15). Total cost of heparin lock administration ($91-$362.50) was found to be more than rt-PA lock ($76) when more than one flush was needed between procedures.
For apheresis use, rt-PA and heparin CVC locks seem to have similar outcomes in preventing CVC malfunction. The convenience of not needing any flushes between procedures and overall cost of administering fewer locks favors rt-PA use when the interval between procedures is >7 days.
用于血液分离术的中心静脉导管（CVC）需要定期封管/冲洗以维持足够的流速。目前缺乏关于血液分离术封管溶液的比较文献，血液分离术的操作间隔时间可能比血液透析更长（数天至数周）。在本研究中，比较了在血液分离术之间使用重组组织型纤溶酶原激活剂（rt-PA）与肝素封管CVC的导管故障率。
在我们机构对10例患者的93次体外光化学疗法进行了回顾性研究。使用约1000 U/mL肝素或2 mg rt-PA作为封管溶液。肝素封管每周至少更换一次，rt-PA封管可留置长达4周。在这些封管后，将在使用CVC时和/或操作过程中发现的血流不足情况分为：无问题、有一些问题或有严重问题。采用二元逻辑回归评估结果的潜在统计学差异。还进行了成本分析。
肝素封管和rt-PA封管在结果上无统计学显著差异（P值 = 0.15）。当两次操作之间需要多次冲洗时，发现肝素封管的总成本（91美元至362.50美元）高于rt-PA封管（76美元）。
对于血液分离术，rt-PA和肝素封管CVC在预防CVC故障方面似乎有相似的结果。当操作间隔时间>7天时，操作之间无需冲洗的便利性以及减少封管的总体成本有利于使用rt-PA。
