Thrombotic and Infective Complications in 3 Temporary Non-Tunneled Central Venous Hemodialysis Catheters

Abstract

Background: Central venous catheter is a widely accepted form of permanent vascular access which is evolved as a bridge to optimal management in hemodialysis patients. Despite great advances, catheter-related thrombosis and catheter-related bloodstream infection cause catheter loss. To mitigate this situation, role of catheter lock solutions has been introduced. As Sodium Bicarbonate is easily available, low cost and associated with less hemorrhagic manifestations. Aim of the study: This study aimed to assess the use of sodium-bi-carbonate as catheter lock solution in preventing hemodialysis catheter loss. Methods: This Longitudinal study was conducted at the department of Nephrology in Dhaka Medical College and Hospital for a period of January 2019 to June 2020 following ethical approval. A total of 228 patients finally entered in the study following selection criteria. Study participants were divided into three groups according to the nature of catheter lock solutions, group A Sodium-bi-carbonate, group B Normal saline and Group C Heparin diluted with normal saline. Each group included 76 patients. All patients were subjected detail history taking and relevant investigations. A central venous catheter was inserted all the needful. Intraluminal SBCLS, NSCLS and HCLS lock solution were used in three groups accordingly. All the patients were followed up at 1st week, 2nd week and 3rd week and all information was recorded in separate case record form. After checking all the data was analyzed by SPSS 23.0. Results: Mean age of the study participants was 54.34 (±8.79). Female respondents were slightly predominant with a percentage of 53.1% and 46.9% male. Socio demographic features were statistically similar in all groups. Catheter related thrombosis was noted at 1.35% in the SBCLS group, 13.69% in the NSCLS group and 8.1% in HCLS group. CRT was lower in the SBCLS group than other two groups with statistical significance (p<.05). Catheter related blood stream infection was observed at 1.35%, 8.21% and 16.21% of patients in the SBCLS, NSCLS and HCLS groups accordingly. In the SBCLS group CRBSI was significantly fewer than other groups (p<.05). Causes of a catheter loss due to malfunction 4.05% in the SBCLS group, 4.1% in NSCLS group and 5.41% in the HCLS group. Conclusion: Data concluded that, standard NaHCO3 solution for locking catheter demonstrated significantly less CRT and CRBSI in comparison to normal saline and heparin diluted normal saline. A further clinical trial with a large study Population is recommended.