Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Lin WT(1), Hui CF(1), Wong PK(1), Wong WM(1), Wong SHS(1), Tsang WY(1)
Affiliation :
(1)Renal Unit, Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Heparin is commonly used as a standard locking solution to maintain patency of hemodialysis (HD) catheters in Hong Kong. However, incidents involving inadvertent heparin injection to patients have been reported, and catheter-related bloodstream infections (CRBSI) pose a common risk among HD patients. This pilot study explores the feasibility of using a neutral-valve closed-system Tego connector with normal saline (NS) flushing as an alternative to maintain the patency of HD catheters and reduce the incidence of CRBSI.
Objectives :
1)To compare the effectiveness of Tego connector with NS flushing versus heparin locking with a standard catheter cap in maintaining patency of HD catheter of HD patients. 2)To evaluate the efficacy of using Tego connector in reducing CRBSI in HD patients with HD catheters.
Methodology :
This pilot study included two phases, each with two stages. Phase I involved patients with temporary HD catheters (Dual Lumen) and Phase II involved patients with permanent HD catheters (PermCath). In each phase, five patients with the specified HD catheter used Tego connector for 3 three weeks (Stage1). If no adverse effects noted, all patients with the specified HD catheters changed to use Tego connector for three months (Stage 2). Prospective data from the intervention group were compared with same patients’ historical data as the control group. Parameters reflecting the patency of HD catheter and CRBSI incidents were recorded in each HD session.
Result & Outcome :
No HD catheter blockage nor CRBSIs were found during the study period. In both Phases, the size of clots aspirated was slightly larger (0.5-1cm), and arterial and venous pressures of HD catheters during HD with similar blood flow rate (BFR) were slightly higher (~10-20mmHg) in the intervention group (using Tego connector with NS flushing) than in the control group (using heparin locking). These differences are not statistically significant (P>0.001). The increase in arterial and venous pressures may attributed to the valve inside the Tego connector. With Tego connectors, exposure of HD catheter hubs to the environment is minimized, potentially reducing CRBSI risks. In conclusion, Tego connector with NS flushing was found effective in maintaining HD catheter patency. Given the potential to prevent heparin-related incidents and reduce the risk of CRBSI, Tego connector with NS flushing was adopted as standard practice among HD patients with HD catheters in UCH
