Optimizing the management of hemodialysis catheter occlusion

Abstract

Hemodialysis catheter occlusion compromises hemodialysis adequacy and increases the cost of care. Repeated administration of alteplase in hemodialysis catheters typically produces only short-term benefits. The purpose of this study was to design, implement and evaluate the efficacy of a step-by-step algorithm to optimize the management of hemodialysis catheter occlusion. The study had a prospective quasi-experimental design in two parts. Baseline data on the use of alteplase and catheter exchange were collected during Part I; while, Part II consisted of algorithm implementation. Rates of alteplase use and catheter exchange per 1000 catheter days were main outcomes of the study. One-hundred and seventy-two catheters in 131 patients were followed up during the course of the study. The vast majority of the study population were on clopidogrel or aspirin (75%); whereas, approximately 11% were on warfarin. The adjusted rate of alteplase use was not significantly different after algorithm implementation (Part I vs. Part II relative risk: 1.10; 95% CI: 0.73 – 1.65, p > 0.05). Similarly, catheter exchange rates were not significantly different in both parts of the study (1.12 vs. 1.03 per 1000 catheter-days, p > 0.05). Regression analysis showed that the rate of alteplase use was inversely related to the catheter age (p < 0.05). In a secondary analysis on a subgroup of patients with occlusion-related catheter exchanges (n = 28), the number of alteplase administrations significantly increased with longer waiting time for catheter exchange (p < 0.05). In conclusion the hemodialysis catheter management algorithm was not effective in decreasing the rate of alteplase use.