Line Thrombosis in Patient on Maintenance Hemodialysis with use of Trisodium Citrate 4% V/S Heparin at Sheikh Zayed Hospital Rahim Yar Khan

Abstract

Background: Conventional Heparin and Tri-sodium citrate 4% are used for locking double lumen catheter after dialysis to prevent line thrombosis. Objectives: To compare the line thrombosis after use of heparin and tri-sodium citrate 4%. Methodology: Randomized controlled trial study involving patient who develop line thrombosis after use of heparin and tri-sodium citrate 4% from February 2020 to August 2020. The study was done on a group of 200 patients who had poor blood flow in double lumen catheter during dialysis. After informed consent first detailed clinical history was taken from patient. Inclusion criteria waspatient of age 14 year of above either gender who presented with renal failure, whom dialysis was performed via temporary catheter or permanent catheter. Conventional heparin and tri-sodium citrate are used as line blocking agents and line thrombosis was observed in patients. The data was entered and analyzed SPSS 20. Results: During this research work 200 double lumen were paced in patients. Out of these, in 100 patients heparin was used as locking solution and locking period was 45-60 days. In remaining 100 patients tri-sodium citrate was used as locking solution in the locking period was 45-60 days. There was no difference in patient’s comorbid conditions in both groups of the patients (Figure1). The catheter change rate was greater in patients whose catheter were locked with heparin (52 patients) as compared to tri-sodium citrate (42 patients). The proportion of the patient who needs replacement of the double lumen were 81% in conventional heparin sulphate and 65% with 4% tri-sodium citrate groups. There was longer insertion time for requiring double lumen for line thrombosis related poor blood flow in patients in which 4% tri-sodium citrate were used for catheter locked with comparison to the group in which heparin sulphate were used for locking (Figure2). The average hospitalization for line related thrombosis was longer in heparin group (10.5 days) as compared to citrate group 3.2 days. (P=0.02) The hospitalization rate was 6% in heparin group as compared to 2.5% in tri-sodium citrate group (P=045%). Conclusion: Tri-sodium citrate 4% is equally effective cheap and beneficial with comparison to heparin sulphate. It showed good outcome as far as change of double lumen or double lumen related infection or hospital admission when compared with heparin sulphate. Randomized trials while using tri-sodium citrate with other anti-coagulant would definitely will decide the better double lumen catheter locking agent. Key Words: End stage kidney failure, Advanced renal disease, Dialysis, double lumen blood flow.