ABSTRACT
BACKGROUND: When regional citrate anticoagulation (RCA) is used in continuous renal replacement therapy (CRRT), one of the key aspects to achieve safe and effective extracorporeal circulation is the management of calcium ions. For calcium-free RCA-CRRT, there are generally two ways to do this: The deep vein and the venous line. The anticoagulant effects of different calcium supplementation pathways have not yet been explored. OBJECTIVE: In this trial, we would test our hypothesis that compared with the subclavian vein, when calcium was infused through the venous line of blood filter catheter, the arterial iCa2+ was lower. METHODS: This was a prospective, single-center, randomized crossover trial. From December 2018 to December 2019, 48 patients with RCA-CRRT at the Department of Intensive Care Unit of the First Hospital of Lanzhou University were selected. According to the different calcium sites, the patients were randomly divided into two groups. The calcium supplementation order of group A (n=24) was the venous line of the blood filter catheter-subclavian vein. Group B (n=24) was supplemented with subclavian vein-the venous line. Blood gas analysis results were compared using blood gas analyzers before and after replacement of the calcium supplementation route in all cases. The primary measurement outcome was the differences between arterial iCa2+ and post-filtration iCa2+ with different calcium supplementation pathways, and the simultaneous recording of pH, K+, and total hemoglobin. The secondary measurement outcomes were the incidences of catheter dysfunction and hypocalcemia during the intervention. The trial was approved by the Ethics Committee of the First Hospital of Lanzhou University (approval No. LDYYLL2018-165) in December 2018. The study was registered on the China Clinical Trial Registration Center (ChiCTRI 800020046) in December 2018. Sample and data collection time is from December 2018 to November 2019, data analysis time and test completion time is December 2019. DISCUSSION: This is the first trial on the anticoagulant effects of calcium-free RCA-CRRT through different calcium supplement routes. We will confirm that the arterial iCa2+ level is slightly lower when calcium is infused in the venous line of blood filter catheter than in the subclavian vein, and the incidence rates of catheter dysfunction and hypocalcemia will help us to determine which site is safer.
ABSTRACT
Objective To formulate a practical nursing education project,improving hemodialysis patients'self -maintenance compliance for central venous catheter with dacron cuff and reducing patients'catheter dysfunction rate.Methods 17 patients with hemodialysis who newly had the central venous catheter with dacron cuff from March 2014 to October 2014 in our hospital,were selected and carried out a guidance of daily maintenance according to Lewin's action research theory.Four steps including plan,action,study and reflection were done spirally.The feasibility and validity of the nursing education project were evaluated by assessing the patients'catheter self maintenance com-pliance,and counted up the catheter dysfunction rate within 12 months.Results The action research practice was conducted for 8 weeks,and included 3 rounds circulation.According to the nursing education team's management method,with the improved education method and adjusted education schedule,refined nursing process,family support system and multi -disciplinary coordination,the knowledge of self -maintenance of the hemodialysis patients were improved,and increased the compliance,reduced the dysfunction rate.Conclusion The dialysis catheter nursing education project of this study has been modified and perfected according to the practice of action research,which could improve patients'self maintenance compliance and effectively reduce catheter dysfunction rate.
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Objective To analyze the related factors of influencing deep vein indwelling catheter dysfunction in hemodialysis patients.Methods A total of 37 cases with deep vein indwelling catheter in hemodialysis patients were selected.They were divided into patent group and blocked group according to the appearance of catheter dysfunction (hemodialysis blood flow less than three times 180 ml/min,adjustment of body position,inversion of tube connection during hemodialysis,requirement of thrombolytic therapy and so on) in 5 months.The common data and biochemical indicator were compared between two groups.Results Patent group had 28 cases,and blocked group had 9 cases.There was no significant difference in age,diabetes mellitus ratio,platelet,low density lipoprotein cholesterol and albumin between two groups (P ＞0.05).Hemoglobin in patent group was lower than that in blocked group [(90.1 ± 13.8) g/L vs.(108.3 ± 11.6) g/L],and there was significant difference(P＜ 0.05).Conclusion Hemoglobin is the correlated factor that effects deep vein indwelling catheter dysfunction after hemodialysis.
ABSTRACT
With the increasing proportion of elderly and diabetic dialysis patients, permanent dual lumen catheters are becoming popular. One of the most frequent causes for the failure of hemodialysis in CRF patients with the tunneled cuffed catheter is the catheter dysfunction. It is thought to be due to encasement of the catheter by fibrin sleeve or fibrin sheath, kinking or malposition of the catheter. Catheter dysfunction due to fibrin sheath formation could sometimes be managed by reversal of arterial and venous lines, urokinase lock or infusion, and catheter exchange. Recently percutaneous fibrin sheath stripping (PFSS) became another modality of salvaging failing tunneled cuffed catheter before attempting catheter exchange. There was no report of applying PFSS to salvage the permanent dual lumen catheter in Korea. Authors recently experienced a case of successful application of PFSS to extend the life of catheter in a CRF patients as a last resort after failure of repeated urokinase trials. It is thought that PFSS is a simple and effective procedure which extends the longevity of permanent dual lumen catheter.