Optimizing the management of hemodialysis catheter occlusion
Abdelmoneim, Ahmed S.
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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.