Introduction:
Catheter-related complications, such as malfunction, infections, and thrombosis, significantly impact the efficacy of hemodialysis in patients with permanent catheters. This study evaluates the clinical outcomes of heparin versus citrate lock solutions in Catheter Related Blood Stream Infections and maintaining catheter patency and reducing related complications.
Methods:
This prospective observational study was conducted at Ruby Hall Clinic, Pune, over 18 months, involving hemodialysis patients with permanent double lumen central venous catheters. Eligible participants included adults over 18 years with various comorbidities, including those with HBV or HCV. Patients with temporary catheters, a history of hemorrhagic diathesis, systemic thrombo-embolic events, or chronic anticoagulation therapy (excluding low-dose aspirin) were excluded. Participants were randomly assigned to receive either a heparin solution (5000 IU/ml) or a 47.5% trisodium citrate solution as a catheter lock at each session's end. Clinical assessments during dialysis included monitoring for clot formation, flow problems, catheter occlusion, and infection signs, with further evaluation of the need for urokinase therapy to restore blood flow.
Results:
The study involved 50 participants (30 males, 20 females; mean age: 55.8±15.2 years) divided into heparin (n=33) and citrate (SEROCIT, n=17) groups. Thrombolysis was required in 30% of cases, with 33.3% in the heparin group and 23.5% in the citrate group, showing no significant difference (p=0.533). Catheter related Blood stream infections occurred more frequently with Heparin (45.4%) compared to Citrate (29.4%), though the difference was not statistically significant (p=0.21). Catheter removal was necessary in 10% of cases, more often with heparin (12.1%) than with citrate (5.9%), but this was not statistically significant (p=0.4). All-cause mortality was reported in 24% of participants, with heparin users experiencing a lower mortality rate (21.2%) compared to citrate users (29.4%), though these differences were not statistically significant.
Conclusions:
This study found that heparin and citrate lock solutions have comparable effects on catheter related blood stream infections and catheter patency, with no significant differences in thrombolysis requirements. While both solutions performed similarly in preventing catheter malfunction, Heparin was associated with higher rates of catheter related blood stream infections. Mortality rates were slightly higher in the citrate group, though these differences were not statistically significant. These findings underscore the need for continuous monitoring and further research to optimize lock solutions for enhanced safety and effectiveness in hemodialysis patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.