The role of urokinase in central venous catheter dysfunction during hemodialysis.

Schouten, R.W. (2014) The role of urokinase in central venous catheter dysfunction during hemodialysis. thesis, Medicine.

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Abstract

Background and Objectives: Use of a central venous catheter (CVC) for hemodialysis (HD) is associated with thrombotic complications and dysfunction resulting in a lower adequacy of dialysis. Use of a CVC has higher morbidity and mortality compared to other vascular access options. The primary aim of this study is 1) to evaluate the effectiveness of urokinase when treating dysfunctional CVCs. Secondary aims are 2) to describe patient and dialysis characteristics of patients using a CVC, 3) to identify indications resulting in the use of a semi-permanent CVC and 4) to describe the incidence of dysfunction, CVC-removal and to describe CVC-survival. Methods: This is a retrospective cohort study were data was obtained from the digital patient file. Analysis was performed with data from all patients with a semi-permanent CVC in 2012 and 2013 in Dianet (AMC). Data from 102 patients were used after exclusion. Dysfunction is defined as a blood flow <200 ml/min measured on the dialysis machine. For the statistical analysis of the primary aim, multivariate linear regression models were used. Results: The mean age was 55 years, 49.5% is male and 60% is Caucasian. The total number of dialysis sessions included is 12,906. 1) No significant effect from urokinase on catheter function has been found. In 63.5% of the dysfunctional sessions urokinase was given as a bedside intervention. After urokinase 66.4% of the CVCs were functional during the same dialysis session or at the start of the subsequent dialysis session. However 60.3% of the dysfunctional CVCs became functional without the use of urokinase. 2) In the multivariable analysis associations with the incidence of dysfunction were found for number of CVCs removed during the study period and the incidence of lumen reversal. No other associations between the incidence of dysfunction and patient characteristics were found to be significant. 3) 46% of the patients with a semi-permanent CVC are waiting for fistula or graft placement or maturation. In 19% no other vascular access option is available. 4) The incidence of dysfunctional sessions is 2.16% of the total sessions. Tunneled single lumen CVCs show a slightly better CVC survival compared to tunneled double lumen CVCs. Femoral CVCs show a higher incidence of dysfunction and lower CVC survival compared to internal jugular CVCs. Conclusion: When using urokinase to improve blood flow in dysfunctional central venous catheters the outcomes are uncertain. No significant effect on blood flow improvement of urokinase has been found. No relevant patient characteristics were found to predict the incidence of dysfunction. New prospective research evaluating different interventions could give more definitive results.

Item Type:	Thesis (Thesis)
Supervisor name:	Son, Prof. Dr. W.J. van
Supervisor name:	Weerd, Dr. N.C. van der
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:00
Last Modified:	25 Jun 2020 11:00
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2079

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