Abstract
Reliable vascular access is necessary for effective hemodialysis. Guidelines recommend chronic hemodialysis via an arteriovenous fistula (AVF), however, in a significant number of patients, permanent central venous catheters (CVCs) are used. The use of a tunneled catheter is acceptable if the estimated dialysis time is less than a year or it is not possible to create an AVF. The main complications associated with CVC include thrombosis and catheter-related bloodstream infections (CRBSIs), which may result in loss of vascular access. The common practice is to use locking solutions to maintain catheter patency and minimize the risk of CRBSI. This paperwork summarizes information on currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction. The PubMed database was systematically searched for articles about locking solutions used in permanent CVCs in hemodialysis patients. Additional studies were identified by searching bibliographies and international guidelines. Articles on end-stage kidney disease patients dialyzed through a permanent CVC were included. Information from each primary study was extracted using pre-determined criteria including thrombotic and infectious complications of CVC use, focusing on permanent CVC if sufficient data were available. Of the currently available substances, it seems that citrate at a concentration of 4% has the best cost-effectiveness and safety profile, which is reflected in the international guidelines. Recent studies suggest the advantage of 2+1 protocols, i.e., taurolidine-based solutions with addition of urokinase once a week, although it needs to be confirmed by further research. Regardless of the type of locking solution, if prophylaxis with a thrombolytic agent is chosen, it should be started from the very beginning to reduce the risk of thrombotic complications. In case of CVC dysfunction, irrespective of the thrombolysis attempt, catheter replacement should be planned as soon as possible.
Highlights
Properly functioning vascular access is key to effective hemodialysis and through this, it helps to ensure the best possible quality of life for the patient with end-stage kidney disease
The most common complications associated with central catheters include intra- or pericatheter thrombosis and catheter-related bloodstream infections (CRBSI) [4]
No meta-analysis evaluating the effect of locking solutions exclusively in the population of patients chronically hemodialysis through permanent central venous catheters (CVCs) was found
Summary
Properly functioning vascular access is key to effective hemodialysis and through this, it helps to ensure the best possible quality of life for the patient with end-stage kidney disease. In recent years in Poland, the percentage of patients with a permanent hemodialysis catheter has been increasing—in 2017, CVCs constituted 31% of created vascular access [2]. The frequency of CVC usage differs among countries; in 2013 in Canada, 45% of patients used CVCs, whereas it was 15% in the USA and less than 10% in Japan and Russia [3] Due to their widespread use, every effort should be made to minimize the number of complications and ensure the longest possible period of functioning. The following paper summarizes information about the currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
