| Autor: |
Van Hulle, Freya, Bonkain, Florence, Tielemans, Christian, De Clerck, Dieter, Janssens, Peter, Pipeleers, Lissa, Van Paesschen, Nico, Roden, Michel, Wissing, Karl Martin |
| Přispěvatelé: |
Faculty of Medicine and Pharmacy, Clinical sciences, Basic (bio-) Medical Sciences, Internal Medicine Specializations |
| Jazyk: |
angličtina |
| Rok vydání: |
2015 |
| Popis: |
Introduction: The use of tunnelled cuffed hemodialysis catheters (TCC) is complicated by the development of thrombosis and catheter related bacteremia (CRB). The optimal regimen to treat thrombotic complications with thrombolytic locking solutions remains controversial. Methods: We retrospectively collected data on all thrombotic dysfunctions of TCC used between 2010 and 2014 at the UZ Brussel Hemodialysis Unit. We reviewed the efficacy of different treatment regimens with Urokinase thrombolytic catheter locks to restore adequate access blood flows and pump pressures. The advantage of multiple administrations of Urokinase locks between successive dialysis sessions was also investigated. Results: 148 patients had in total 773 thrombotic dysfunctions. Urokinase 50000 IU in each catheter lumen restored adequate access blood flow to more than 250 ml/min in 80% of treatments, with increases of mean blood flow by 54 ml/min. Normalisation of arterial and venous pump pressures occurred in 90% of dysfunctional catheters with a reduction of mean aspiration (arterial) pressure by 25 mm Hg and mean outflow (venous) pressure by 32 mm Hg (all p < 0.0001). Multiple administrations of Urokinase locks during successive dialysis sessions for the same thrombotic event improved access blood flow and pump pressures only in catheters with persistent thrombotic dysfunction after the first lock (p < 0.0001) but had no added value in case full restoration of access function had occurred after the first treatment. Incidence rate of CRB was 0.23/1000 catheter days in this population. Conclusion: Urokinase was effective to treat TCC-related thrombotic dysfunction. Multiple administrations were more effective than one single administration only if normal function was not restored after the first treatment. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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