Catheter Thrombosis Research Articles

Urokinase lock or flush solution for prevention of bloodstream infections associated with central venous catheters for chemotherapy: a meta-analysis of prospective randomized trials.

Intravascular devices (IVDs) carry significant risk of device-associated bloodstream infection (BSI). Catheter thrombosis increases the likelihood of microbial colonization of the catheter and BSI. Urokinase has been studied for the prevention of BSI associated with IVDs. We undertook a systematic review to determine the efficacy of urokinase-heparin lock or flush solution compared with heparin alone in preventing IVD-associated BSI. Computerized databases were searched for relevant publications in English from January 1966 to 1 January 2007. We identified randomized controlled trials comparing a urokinase-heparin lock or flush solution with heparin alone for prevention of BSI associated with long-term IVDs. Summary effect sizes were calculated with assessment of heterogeneity. Five randomized, controlled trials involving a total of 991 patients being treated with IVDs met the inclusion criteria; all five studies were conducted among patients with cancer; three of these studies were undertaken in children and two in adults. The summary risk ratio with a urokinase-heparin lock solution for IVD-associated BSI was 0.77 (95% confidence interval [CI], 0.60-0.98; p=0.01). Results of the test for heterogeneity were not statistically significant (p=0.53). Use of a urokinase lock solution in high-risk patient populations being treated with long-term central IVDs may reduce the risk of BSI. However, there are few randomized trials and methodologic limitations of these preclude more robust recommendations regarding the use of urokinase to prevent BSI. Further adequately powered studies should seek to evaluate the efficacy of urokinase and optimize dosage and instillation regimen.

A RARE CAUSE OF CONFUSION AND SYNCOPE: THROMBOSIS OF DIALYSIS CATHETER. CASE PRESENTATION AND REVIEW OF CURRENT LITERATURE

Ponte Academic JournalDec 2018, Volume 74, Issue 12 A RARE CAUSE OF CONFUSION AND SYNCOPE: THROMBOSIS OF DIALYSIS CATHETER. CASE PRESENTATION AND REVIEW OF CURRENT LITERATURE Author(s): Mustafa begenc Tascanov ,M. Emre ErkusJ. Ponte - Dec 2018 - Volume 74 - Issue 12 doi: 10.21506/j.ponte.2018.12.5 Abstract:A Rare Cause of Confusion and Syncope: Thrombosis of Dialysis Catheter. Case Presentation and Review of Current Literature SUMMARY Superior vena cava (SVC) syndrome is a complete or partial obstruction of SVC and is occured an emergency situation. While currently 80% of the etiologies are consisted of malignant disorders, in recent years there is an increase in iatrogenic causes such as pacemaker wires and long term central venous catheters. Here we presented a case of SVC syndrome caused by right subclavian vein catheter for two years for dialysis treatment due to chronic renal insufficiency and review of the literature. Keywords: Dialysis Catheter, Vena cava syndrome ,Confusion Download full text:Check if you have access through your login credentials or your institution Username Password

Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit.

Tolunay İ, Yıldızdaş RD, Elçi H, Alabaz D. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr 2018; 60: 63-69. In catheter-using units as pediatric intensive care, it is important to know the complications that may occur during the insertion and use of central venous catheterization (CVC), and to take appropriate measures in order to reduce the mortality and morbidity of critical patients. The aim of this study was to evaluate CVC and catheter related complications in our tertiary pediatric intensive care unit. For this prospective study, 155 central venous catheters and/or hemodialysis catheters used with 106 patients, between August 2014 and August 2015 were evaluated. Demographic information about patients, catheter insertion procedure and catheter related complications were recorded. Sixty-two (58.5%) male and forty-four (41.5%) female patients were evaluated in this study. The median age was 67.5 months (1-212). The mean dwell time of catheters was 10.54±8 days. Twenty-two (14.2%) catheters were removed from patients because of catheter related complications. The mean dwell time of complicated catheters was 10.6±8.5 days and there was no statistically significant difference between complicated and non-complicated catheters. Catheter related blood stream infections was diagnosed in 5.1% (8/155) patients and these catheters were removed from patients. Including these patients, positive blood culture was found to be at 14.2% (22/155). The mean dwell time of catheters with positive blood culture was 14.25±7.3 days. The mean dwell time of catheters with positive blood culture was statistically significantly longer than catheters with negative blood culture. In the 3 patients who developed catheter thrombosis, 2 patients were followed up because of infection/sepsis and 1 patient had a neurological disease. Catheter thrombosis developed in 1 femoral vein and 2 internal jugular veins. The development of central venous catheter complications depends on many different factors and it is possible to reduce the complications with precautions taken during replacement and daily use.

Femoral tunneled hemodialysis catheter as a permanent access for hemodialysis patients

Background Vascular access (VA) remains the cornerstone in HD patients. The survival of the patients becomes risky if approaches like arteriovenous fistulae, grafts, and thoracic tunneled central catheters are used with no benefits. The options become limited to transplantation, dialysis through the peritoneum, and catheter insertion translumbarally or femorally, which in some cases is the only available approach. Methods We are discussing our experience from Mataria Teaching Hospital with 17 patients; in those patients, all the vascular procedures were used with no benefits. We could not perform other options like transplantation or peritoneal dialysis. Hence, we chose femoral tunneled catheters (FTC) permanent VA. The follow-up period ranged between 2 and 14 months, with a mean period of 10 months. The mean age of the patients was 55 ( 40–70) years. In 10 patients, a Permcath was inserted, and in the other seven, a Duraflow was inserted. All patients were administered warfarin after bridging with low molecular weight heparin to avoid occurring of catheter thrombosis. Aseptic procedures and personal hygiene were followed. Result Two patients died at 5 and 12 months, correspondingly, with a functional catheter, owing to causes other than related to the FTC. In one patient, accidental pulling of the catheter occurred, so the site of the catheter was changed at 5 months. One catheter was altered because fl ow became inadequate after 8 months. No patients presented with deep vein thrombosis or late hemorrhage. In one patient, the catheter functioned for 14 months after insertion. In four patients, the catheter was removed, after 2, 3, 4, and 14 months, correspondingly, as they developed catheter-related septicemia. In two patients, the catheter was removed owing to perforation after 2 months.

Port catheter complications and thrombosis issues: assessment of 114 patients with port catheter implantation by single surgeon

Background: We provided a comparative presentation of complications seen in 114 patients with port catheter implantation. In addition, we addressed whether patients with catheter-related thrombosis have distinctive features by assessing patients who developed thrombosis either at the catheter implant site or vascular bed.
 Methods: In this study, we analyzed data from 114 patients who underwent subclavian venous port catheter implantation by a single surgeon at Kayseri Teaching Hospital (Turkey) during 2013 to 2016. Subclavian port catheter was inserted in all cases. The diagnosis of port thrombosis was made by Doppler sonography or thorax CT scan with contrast enhancement in patients presenting with edema at upper extremity, swelling or pain at neck, and/or dysfunctional port.
 Results: Seroma was detected in only one case, lymphedema developed in one case (0.8%), and pneumothorax was observed in 3 cases. The subclavian vein was implanted on the right side in all patients with pneumothorax. None of these cases were associated with thrombosis. Port infection was observed in one case (0.8%). There was also one case (0.8%) of skin necrosis. The port was removed in 15 patients due to several reasons, which are indicated in Table 2. Thromboembolic events were observed in 11 of the 114 patients while port thrombosis was observed in 7 patients. The rate of hypertension in the thromboembolism group was 61.1% (11/18 individual) while the rate of hypertension in the group without thromboembolism was 28.1% (27/96 individuals); this difference was statistically significant (p = 0.006).
 Conclusion: In this study, based on complications observed in patients with catheter-related thrombosis, factors such as smoking or diabetes mellitus were seen to be linked to thromboembolism and should be taken into consideration. Moreover, it was observed that hypertension had a significant association with thromboembolism.

The nursing and complication observation of temporary cardiac pacemaker resettlement in patients with slow arrhythmia

Objective To explore the care of temporary cardiac pacemakers in patients with slow arrhythmia. Methods A retrospective analysis was performed on 120 patients with slow arrhythmias involved in temporary cardiac pacemakers from January 2015 to November 2016 in the CCU. Results All the patients underwent surgery, two of them were removed, one of them was formed by cardiac catheter thrombosis, and after treatment, all recovered and discharged. Conclusion It can reduce the risk of operation and improve patient satisfaction by providing predictive nursing after interventional cardiac pacemaker implantation and enhancing the observation of clinical complications. It deserves clinical promotion. Key words: Temporary cardiac pacemaker; Implanted operation; Nursing; Complications

Yeni Doğanda Umblikal Ven Kateterizasyonu Malpozisyonuna Sekonder Gelişen İntrakardiyak Kitle

Umbilical vein catheterization is a routine procedure of neonatal intensive care units, and only rare complications associated with catheter malposition have been described in the literature. We herein present an infant boy (28 days old, 4 kg) with an intracardiac mass diagnosed after umbilical vein catheterization. The patient was referred to our clinic with a diagnosis of catheter migration and thrombosis, but this could not be confirmed during surgery. Pathological analysis of the excised intracardiac mass revealed nonbacterial thrombotic endocarditis. Our case confirms the essentiality of controlling the location of the umbilical venous catheter after its insertion.

Postmarketing experience with Neutrolin\xae (taurolidine, heparin, calcium citrate) catheter lock solution in hemodialysis patients

Catheter-related bloodstream infections (CRBSI) are major complications for patients with life-threatening conditions requiring chronic vascular catheterization. The wide range of etiologic microbes and the ongoing development of resistance to antimicrobials with specific mechanisms of action make this an appropriate target for applying a nonspecific antimicrobial therapeutic. Taurolidine hydrolyzes into two antimicrobial moieties, formaldehyde and methylene glycol, which react with microbial surfaces. Neutrolin® (taurolidine, heparin, calcium citrate) was recently introduced in Germany as an antimicrobial catheter lock solution. This postmarketing experience collected data on 201 patients at 20 centers from January 2014 through September 2016. Likely CRBSI was observed in 13 episodes in 47,118 days (0.2759 per 1000 days [0.1468, 0.4718]). Thrombosed catheter was observed in seven catheters in 47,118 days (0.1486 per 1000 days [0.0595, 0.3061]). No adverse drug reactions that led to the discontinuation of Neutrolin® use were reported. Two patients experienced occasional transient dysgeusia. Neutrolin®, when used in conjunction with guideline-based catheter care, showed reduction in the rate of both CRBSI and catheter thrombosis relative to recent historical controls.

Hidden morbidity of ethanol lock therapy.

Long-term central venous catheters are essential in sustaining growth and development in patients with intestinal failure (IF). Several strategies have been developed to prevent and treat catheter-related blood stream infections (CRBSIs), including ethanol lock therapy. We sought to evaluate the efficacy of ethanol lock therapy in our IF population. This is a retrospective review of IF patients treated with ethanol lock therapy at a single institution from 2006 to 2013. We evaluated the number of catheter days, rate of CRBSI per 1000 catheter days, rate of central venous catheter (CVC) thrombosis, rate of CVC breakage, total number of CVC replacements, total number of hospital admissions, and total number days in the hospital. We identified 19 patients who underwent ethanol lock therapy for CRBSI. There was no difference in CRBSI rate prior to (5.6 per 1000 catheter days) and after (7 per 1000 catheter days) initiation of ethanol lock therapy. The mean rate of thrombosis increased from 0 to 3 per 1000 catheter days with ethanol lock therapy (p < 0.05). In addition, the CVC breakage rate increased from 0 to 13.7 per 1000 catheter days with ethanol lock therapy (p < 0.001). Hospital admissions and catheter-related ER visits increased following the initiation of ethanol lock therapy. Contrary to other studies, there was no difference in CRBSI rate prior to and after initiation of ethanol lock therapy. Factors in the methodology of ethanol lock therapy may influence the effectiveness of infection prevention associated with ethanol lock therapy, as well as the rate of line breakage, line thrombosis, and the need for line replacement.

Small volume plasma exchange for Guillain-Barr\xe9 syndrome in resource poor settings: a safety and feasibility study

BackgroundIn Bangladesh, most patients with Guillain-Barré syndrome (GBS) cannot afford standard treatment with intravenous immunoglobulin (IVIG) or a standard plasma exchange (PE) course, which partly explains the high rate of mortality and residual disability associated with GBS in this country. Small volume plasma exchange (SVPE) is an affordable and potentially effective alternative form of plasma exchange. SVPE is the repeated removal of small volumes of supernatant plasma over several days via sedimentation of patient whole blood. The aim of this study is to define the clinical feasibility and safety of SVPE in patients with GBS in resource poor settings.MethodsA total of 20 adult patients with GBS will be enrolled for SVPE at a single center in Bangladesh. Six daily sessions of whole blood sedimentation and plasma removal will be performed in all patients with GBS with a target to remove an overall volume of at least 8 liters (L) of plasma over a total of 8 days. Serious adverse events (SAE) are defined as the number of patients developing severe sepsis associated with the central venous catheter or deep venous thrombosis in the limb where the catheter is placed for SVPE. Based upon a predictive success rate of 75%, the SVPE procedure will be considered safe if less than 5 of 20 SVPE-treated GBS patients have a SAE. The procedure will be considered feasible if 8 L of plasma can be removed in at least 15 of 20 patients with GBS who receive SVPE. In addition, detailed clinical and neurological outcome assessments will be performed until discharge of the patient from the hospital and up to 4 weeks after study entry.DiscussionThis is the first clinical study to evaluate the feasibility and safety of SVPE as a potential alternative low-cost treatment for the patients with GBS in resource poor settings.Trial registrationClinicaltrials.gov NCT02780570

An omniphobic lubricant-infused coating produced by chemical vapor deposition of hydrophobic organosilanes attenuates clotting on catheter surfaces

AbstarctCatheter associated thrombosis is an ongoing problem. Omniphobic coatings based on tethering biocompatible liquid lubricants on self-assembled monolayers of hydrophobic organosilanes attenuate clotting on surfaces. Herein we report an efficient, non-invasive and robust process for coating catheters with an antithrombotic, omniphobic lubricant-infused coating produced using chemical vapor deposition (CVD) of hydrophobic fluorine-based organosilanes. Compared with uncoated catheters, CVD coated catheters significantly attenuated thrombosis via the contact pathway of coagulation. When compared with the commonly used technique of liquid phase deposition (LPD) of fluorine-based organosilanes, the CVD method was more efficient and reproducible, resulted in less disruption of the outer polymeric layer of the catheters and produced greater antithrombotic activity. Therefore, omniphobic coating of catheters using the CVD method is a simple, straightforward and non-invasive procedure. This method has the potential to not only prevent catheter thrombosis, but also to prevent thrombosis on other blood-contacting medical devices.

Longitudinal dialysis adequacy and clinical performance of the VectorFlow hemodialysis catheter: a prospective study.

To report clinical performance and longitudinal assessment of hemodialysis adequacy with the Arrow-Clark VectorFlow catheter, a symmetrical-tip device with a distal lumen configuration designed to reduce platelet shear stress and catheter thrombosis. We prospectively enrolled patients who required de novo placement of a chronic tunneled catheter for hemodialysis or exchange of a dysfunctional catheter as part of an Institutional Review Board (IRB)-approved protocol. Catheter patency, Kt/V, mean blood-flow (Qb), and pump pressures were obtained at baseline and at monthly intervals to 90 days. Forty-six subjects were enrolled into the study. During the 90-day observation period, maximum blood-flow rate averaged 355-398 mL/minute; mean Qb averaged 333-392 mL/minute. Mean Kt/V values were consistently ≥1.5. Dwell-time was 15-114 days, for a total of 2997 catheter days (mean 71.4 days). Excluding patients who died during the study and those receiving surgical access, overall intervention-free catheter patency rate was 94.9%, 92.2% and 88.8% at days 30, 60, 90, respectively. There were no acute complications. During the follow-up period, three patients developed complications (6.5%). Two catheter infections occurred (0.7/1000 catheter days) and one catheter malfunctioned; a rate of 1.0/ 1000 catheter days for all complications. The VectorFlow catheter produced safe, effective hemodialysis with Kt/V ≥1.5. A single catheter occlusion occurred and a low rate of infection was seen. Results support the hypothesis that the VectorFlow design reduces thrombogenic risk during clinical performance.

Recurrence of venous thromboembolism among adults acute leukemia patients treated at the University of Texas MD Anderson Cancer Center: Incidence and risk factors

The purpose was to determine the incidence and risk factors for venous thromboembolism (VTE) recurrence among adult acute leukemia patients. We performed a retrospective study of adult acute leukemia patients who were treated at our institution between November 1999 and May 2005. Medical records of 139 patients with an initial VTE were reviewed and followed up to May 2010 for VTE recurrence. Of these 139 patients [86 with acute myelogenous leukemia (AML), 53 with acute lymphocytic leukemia (ALL)], 27 (19.4%, 16 AML and 11 ALL) had VTE recurrence. The overall incidence rate of VTE was 8.6 per 100 person-years (median follow-up time: 0.9years). It was 5.9 and 12.4 per 100 person-years among ALL and AML patients, respectively. The cumulative proportion of recurrent VTE was 2.16%, 10.9%, 16.6%, 25.9%, 30.6%, and 34.2% at 1month, 6months, 1year, 3years, 5years, and 7years, respectively. In a multivariate Cox hazards model, significant predictors for VTE recurrence included catheter thrombosis [adjusted hazard ratio (aHR)]:6.3, 95%CI:1.17–34.0), prior history of hematologic cancer (aHR:4.2, 95%CI:1.5–11.2), chronic lung disease (aHR: 3.4, 95%CI:0.92–12.5), psychological disorder (aHR: 4.3, 95%CI:1.5–12.2), and liver disease (aHR: 3.8, 95%CI: 1.04–14.3). VTE recurrence is common among adult acute leukemia patients and it continues up to 7years after the initial episode. Catheter thrombosis, a history of hematologic malignancy antecedent to acute leukemia, and lung, liver and psychiatric co-morbidities increase the patient risk for VTE recurrence. Further studies should be conducted to improve the prevention of VTE recurrence in leukemia patients.

Current Recommendations for the Prevention and Treatment of Venous Thromboembolism in Cancer Patients

About 20% of patients suffer from venous thromboembolism (VTE) during oncology disease. Active cancer, along with cancer therapy, increases the risk of VTE, especially in the first 6 months after diagnosis. Most often VTE accompanies haematological malignancies and CNS tumours, and gastrointestinal, breast, lung, ovary and uterine cancer. The presence of distant metastases, together with the implantation of a central venous catheter, increases the risk even more. A cancer patient also has a 2-5× higher risk of recurrence of VTE during anticoagulant therapy than patients without a malignancy, as well as a 2-6× higher risk of serious bleeding. Thromboembolic disease is also an independent prognostic factor for death in patients with malignant tumours. Management of VTE is a part of everyday oncological practice, and oncologists should be aware of the basic recommendations regarding individual medical procedures and the clinical situations that may occur in cancer patients. They should also be able to adequately treat VTE when it occurs. It is necessary to consider some specificity during prophylaxis, diagnostics and treatment of venous thromboembolism in cancer care. The International Initiative on Thrombosis and Cancer (ITAC-CME) has created a mobile application based on international guidelines for the prevention and treatment of venous thromboembolism. It is a simple schematic algorithm for making decisions, and it helps in choosing the best therapeutic strategy and supports the judicious and appropriate use of anticoagulants for prophylaxis and treatment of VTE in cancer patients. This text contains a summary of the recommendations applicable in routine clinical practice.Key words: venous thromboembolism - cancer - central venous catheter thrombosis - guidelines This work was supported by Czech Ministry of Health - RVO (MMCI, 00209805). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 1. 8. 2016Accepted: 26. 10. 2016.

Analysis of the role of cluster-nursing on the nursing quality and infection prevention of patients inserted with central venous catheter in ICU

Objective To analyze the role of cluster-nursing on the nursing quality and infection prevention of patients inserted with central venous catheter in ICU. Methods A total of 180 cases of ICU patients inserted with central venous catheter in our hospital from January 2013 to December 2015 were selected as the research objects and were randomly divided into observation group and control group, 90 cases in each group.The observation group was treated with cluster nursing, while the control group received routine care measures.The quality of nursing and prevention of infection of patients of the two groups were compared. Results The puncture-site infection, catheter-related bloodstream infection of the observation group were lower than that of the control group, and the differences were statistically significant(P<0.05). The incidence of catheter prolapse, plugging, thrombosis and unplanned extubation of the observation group were lower than that of the control group, and the differences were statistically significant(P<0.05). Time of indwelling of catheters and the length of hospital stay of the observation group days were shorter than that of the control group, and the differences were statistically significant(P<0.05). The satisfaction for nursing of the observation group was significantly higher than that of the control group, and the difference was statistically significant(P<0.05). After treatment, the scores of quality of life of the observation group were significantly higher than that of the control group, and the difference between the two groups was statistically significant(P<0.05). Conclusions Cluster nursing can reduce and prevent the infection rate of ICU patients inserted with venous catheter and the incidence rate of other complications, meanwhile it can reduce the unplanned extubation of catheter and shorten the indwelling time and length of hospital stay, moreover it can improve the satisfaction for nursing and quality of life of patients, which is recommended for the clinical promotion and use. Key words: Cluster nursing; Central venous catheter; Quality of care; Infection

376 - Catheter Thrombosis in Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) Recipients

376 - Catheter Thrombosis in Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) Recipients

Life-saving vascular access in vascular capital exhaustion: single center experience in intra-atrial catheters for hemodialysis.

Intra-atrial catheter (IAC) placement through an open surgical approach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion. To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure. The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center. Seven patients were submitted to twelve IAC placements. Bleeding (6/7) and infections (3/7) were the main complications in the early postoperative period. Two (2/7, 29%) patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5). During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60) months and the mean IAC patency was 8 ± 11 (0-34) months. Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.

Fever in Thromboembolic Disease: Risk Factors, Central Venous Catheter Thrombosis and Recurrence

Thromboembolic disease (VTE) is a very important cause of morbidity and mortality in cancer patients, with a recurrence rate of 10-17% in patients treated with anti-vitamin K and 6-9% in low molecular weight heparin (LMWH). This case reflects the recurrence of VTE, differential diagnosis in the presence of pleural effusion+fever and the management of central venous catheter-associated thrombosis (CVC).

Post-Thrombotic Syndrome and Functional Disability in Patients with Upper Extremity Deep Vein Thrombosis: A Prospective Cohort Study

Introduction. Upper extremity deep vein thrombosis (UEDVT) is a relatively uncommon event with potentially serious complications. Its clinical outcomes are not well studied. The objective of this study was to assess the incidence of post-thrombotic syndrome (PTS) and functional disability in patients with UEDVT.Patients and methods. This was a pre-specified analysis of a prospective cohort study at 5 Canadian centres. We enrolled adult patients with a symptomatic UEDVT confirmed by compression ultrasound involving the brachial or more proximal veins, with or without a pulmonary embolism (PE). Exclusions included pregnancy, dialysis catheter thrombosis, active or high bleeding risk, platelet count <100x109/L, creatinine clearance < 30 ml/min, on warfarin for other indications, hemodynamically unstable PE, acute leukemia or undergoing a stem cell transplant within 3 months, geographical inaccessibility, life expectancy <3 months or treatment with low molecular weight heparin (LMWH) or warfarin for more than 7 days since diagnosis. Standardized treatment regimens were used as follows: spontaneous or central venous catheter (CVC)-related UEDVT were treated with dalteparin at therapeutic doses for at least 5 days followed by warfarin adjusted according to INR results. Spontaneous UEDVT was treated for at least 6 months and CVC-related events were treated for at least 3 months or for as long as the line remained in place and for at least 1 month after line removal. Cancer patients with non CVC-related UEDVT were treated using dalteparin alone for a minimum of 6 months. Outcomes were assessed at 12, 18 and 24 months and included the occurrence of PTS evaluated using a modified Villalta Score. PTS was defined for patients with a score of 5 or greater and severe PTS was defined by a score of 15 or higher. Functional disability was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Patients were followed for 2 years. Data was analyzed using descriptive statistics. Confidence intervals for proportions were estimated using the Wilson’s score method. Groups were compared using χ2 and Student’s t- tests, as appropriate. The study was approved by all institutional review boards.Results. Between 2009 and 2012, we enrolled 141 patients: 75 with spontaneous and 66 with CVC related UEDVT. Mean age was 51 years and 55% were males. There were 78, 59 and 56 patients with evaluable data at 12, 18 and 24 months, respectively. The percentage of patients with ipsilateral PTS is shown in Table 1. There was no difference between patients with spontaneous or CVC- related UEDVT. Functional disability scores are shown in Table 2. Overall, patients developing PTS had higher functional disability at all time points, compared to patients without PTS.Conclusion. In this prospective cohort study PTS occurred in approximately one fifth of patients after UEDVT and was associated with more functional disability, although the majority of cases were mild according to the modified Villata score. No differences were observed between CVC-related and spontaneous UEDVT. [Display omitted] [Display omitted] DisclosuresLazo-Langner:Bayer: Honoraria; Pfizer: Honoraria; Daiichi Sankyo: Research Funding. Wells:Itreas: Other: Served on a Writing Committee; BMS/Pfizer: Research Funding; Bayer Healthcare: Other: Speaker Fees and Advisory Board; Janssen Pharmaceuticals: Consultancy. Carrier:BMS: Research Funding; Leo Pharma: Research Funding. Kovacs:Daiichi Sankyo Pharma: Research Funding; LEO Pharma: Honoraria; Bayer: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding.

Comparison of sodium citrate and heparin in locking central vein hemodialysis catheter

Objectives To investigate long-term efficacy and safety of sodium citrate and heparin in locking central cenous hemodialysis catheter. Methods 48 hemodialysis patients with long-term cuffed catheter in our hospital were enrolled into this study.All patients were randomly divided into the experimental group (n=24) and the control group (n=24), and locked central vein with cit- rate and heparin. The dialysis blood flow, catheter related infection (CRIS), catheter thrombosis differences, changes of serum calcium ion (Ca2+ ) , magnesium ions (Mg2+ ), aspartate amino acid transaminase (AST) and alanine aminotransferase (ALT) were observed and compared before and after operation. The changes of coagulation function, hemoglobin, blood platelet count and adverse reactions were compared between the two groups. Results 955 sessions? of hemodialysis in the control group and 962 sessions of hemodialysis in the experiment group were performed during 6 months. Frequency of CRIs in the experimental group was significantly lower than the control group (P 0.05). PT, APTT, hemoglobin and platelet count had no significant difference between the two groups. The PT and APTT in the experimental group were significantly higher than in the control group (P<0.05). No serious adverse reaction happened in the two groups except gastrointestinal symptoms in 2 patients. Conclusions Sodium citrate and heparin in locking central vein hemodialysis catheter has advantages of less incidence of catheter-related infection events, and less adverse reaction, higher security, but it may increase the risk of catheter thrombus. A reasonable treatment should be considered on a case-by case basis to ensure usage safety of anticoagulant. Key words: Renal Dialysis; Anticoagulants