Optimizing the management of hemodialysis catheter occlusion
| dc.contributor.author | Abdelmoneim, Ahmed S. | |
| dc.contributor.examiningcommittee | Collins, David (Pharmacy) Miller, Lisa (Medicine) | en |
| dc.contributor.supervisor | Vercaigne, Lavern (Pharmacy) | en |
| dc.date.accessioned | 2010-04-09T15:17:01Z | |
| dc.date.available | 2010-04-09T15:17:01Z | |
| dc.date.issued | 2010-04-09T15:17:01Z | |
| dc.degree.discipline | Pharmacy | en_US |
| dc.degree.level | Master of Science (M.Sc.) | en_US |
| dc.description.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. | en |
| dc.description.note | May 2010 | en |
| dc.format.extent | 1231163 bytes | |
| dc.format.mimetype | application/pdf | |
| dc.identifier.uri | http://hdl.handle.net/1993/3951 | |
| dc.language.iso | eng | en_US |
| dc.rights | open access | en_US |
| dc.subject | Hemodialysis | en |
| dc.subject | Catheter | en |
| dc.subject | Alteplase | en |
| dc.subject | Algorithm | en |
| dc.title | Optimizing the management of hemodialysis catheter occlusion | en |
| dc.type | master thesis | en_US |