Tuggle Thomas S, Noureddine Lama, Hobbs Ryan A
Department of Pharmacy, Carilion Clinic-Roanoke Memorial Hospital, Roanoke, Virginia, USA.
Department of Internal Medicine, Division of Nephrology, University of Iowa Hospitals and Clinics, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
Semin Dial. 2025 Jul-Aug;38(4):282-285. doi: 10.1111/sdi.13260. Epub 2025 Jun 5.
Multiple in vitro and in vivo studies indicate that there is a significant amount of dialysis catheter lock leak with tunneled and nontunneled dual lumen hemodialysis (HD) catheters. The impact of heparin 1000 unit/mL HD catheter lock on outcomes in patients on therapeutic heparin has not been previously reported.
Twenty-nine patients with 42 patient events on HD or continuous renal replacement therapy (CRRT) via double lumen catheters were retrospectively analyzed. Study patients received heparin 1000 unit/mL HD catheter lock while on therapeutic intravenous heparin. All patients had stable activated partial thromboplastin times (PTT) prior to catheter locking and had a PTT drawn within 6 h after administration of the heparin HD catheter lock.
The average prelock PTT was 56 s and postlock PTTs increased on average to 85 s (p < 0.0001). PTTs were significantly higher when drawn closer to the administration time of the heparin catheter lock. Major bleeding occurred in many surgical patients after heparin HD catheter lock administration.
Citrate or saline HD catheter lock may be preferable to heparin HD catheter lock in patients on intravenous heparin infusions, especially in high-bleed-risk surgical patients.
多项体外和体内研究表明，带隧道和不带隧道的双腔血液透析（HD）导管存在大量透析导管封管渗漏。此前尚无关于1000单位/毫升肝素HD导管封管对接受治疗性肝素治疗患者预后影响的报道。
回顾性分析29例通过双腔导管进行HD或连续性肾脏替代治疗（CRRT）的患者发生的42次患者事件。研究患者在接受治疗性静脉肝素治疗时接受1000单位/毫升肝素HD导管封管。所有患者在导管封管前活化部分凝血活酶时间（PTT）稳定，且在给予肝素HD导管封管后6小时内进行了PTT检测。
封管前平均PTT为56秒，封管后PTT平均增至85秒（p<0.0001）。在更接近肝素导管封管给药时间进行检测时，PTT显著更高。许多手术患者在给予肝素HD导管封管后发生了大出血。
对于接受静脉肝素输注的患者，尤其是高出血风险的手术患者，柠檬酸盐或生理盐水HD导管封管可能比肝素HD导管封管更可取。
