Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.
Ren Fail. 2022 Dec;44(1):1501-1518. doi: 10.1080/0886022X.2022.2118068.
A significant proportion of incident and prevalent hemodialysis patients have central venous catheters for vascular access. No consensus is available on the prevention of catheter dysfunction or catheter-related bloodstream infections in patients undergoing hemodialysis by means of catheter lock solutions.
We reviewed the effects of single and combined anticoagulants with antibacterial catheter lock solutions or other antimicrobials for the prevention of thrombosis or infections in hemodialysis patients. Relative risks with 95% confidence intervals for trials of the same type of catheter locking solution were pooled.
We included original research articles in English from PubMed, EMBASE, SpringerLink, Elsevier and Ovid using the search terms 'hemodialysis,' 'central venous catheter,' 'locking solution,' 'UFH,' 'low molecular weight heparin,' 'EDTA,' 'citrate,' 'rt-PA,' 'urokinase,' 'gentamicin,' 'vancomycin', 'taurolidine,' 'sodium bicarbonate,' 'hypertonic saline' and 'ethanol' and 'catheter'.
Low-dose heparin lock solution (< 5000 U/ml) can efficiently achieve anticoagulation and will not increase the risk of bleeding. Low-concentration citrate (< 5%) combined with rt-PA can effectively prevent catheter infection and dysfunction. Catheter-related infections may be minimized by choosing the appropriate antibiotic and dose.
There is a lack of follow-up validation data for LMWH, EDTA, taurolidine, sodium bicarbonate, ethanol, and other lock solutions.
Since catheterization is common in hemodialysis units, studies on long-term treatment and preventative strategies for catheter dysfunction and catheter-related infection are warranted.
相当一部分新发生和现患的血液透析患者都需要使用中心静脉导管作为血管通路。目前对于使用导管封管液预防血液透析患者导管功能障碍或导管相关血流感染，尚无共识。
我们回顾了单一和联合抗凝剂与抗菌导管封管液或其他抗菌药物在预防血液透析患者血栓形成或感染方面的效果。对相同类型的导管封管液进行试验的相对风险，用 95%置信区间表示，并进行了汇总。
我们纳入了来自 PubMed、EMBASE、SpringerLink、Elsevier 和 Ovid 的英文原始研究文章，使用的检索词包括“血液透析”“中心静脉导管”“封管液”“UFH”“低分子肝素”“EDTA”“枸橼酸盐”“rt-PA”“尿激酶”“庆大霉素”“万古霉素”“替考拉宁”“碳酸氢钠”“高渗盐水”和“乙醇”以及“导管”。
低剂量肝素封管液（<5000 U/ml）可以有效地实现抗凝作用，且不会增加出血风险。低浓度枸橼酸盐（<5%）联合 rt-PA 可以有效预防导管感染和功能障碍。选择合适的抗生素和剂量可以最大限度地减少导管相关感染。
缺乏关于 LMWH、EDTA、替考拉宁、碳酸氢钠、乙醇和其他封管液的长期随访验证数据。
由于在血液透析单位中导管插入术很常见，因此有必要进行研究以确定导管功能障碍和导管相关感染的长期治疗和预防策略。
