[The impact of sodium citrate on dialysis catheter function and frequency of catheter-related bacteriemia and haemorrhage].

Maciej Szymczak, Wacław Weyde, Józef Penar, Tomasz Gołebiowski, Katarzyna Madziarska, Magdalena Krajewska, Marian Klinger

Index: Postepy. Hig. Med. Dosw. 63 , 457-64, (2009)

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Abstract

Vascular access is one of the most important problems of hemodialysis therapy. It is known that an arteriovenous fisutla provides the best vascular access, but its creation is not always possible. Other solutions, such as the insertion of a central venous catheter, are then required. Adequate protection of such catheters by interdialytic fill with locking solution affects the frequency of hemodialysis-related complications. The most widespread catheter locking solution is heparin. Sodium citrate is being used more frequent recently. Available data indicate that hemorrhage is 11.9 times more frequent if the catheter locking solution is 5000 IU/ml heparin than if 4% sodium citrate or 1000 IU/ml heparin is used. Other data indicate that the frequency of infection is statistically decreased when 30% sodium citrate is used to fill the catheter instead of 5000 IU/ml heparin. Analogous data on 46.7% sodium citrate are not consistent. It seems that the use of 4% sodium citrate instead of 5000 IU/ml heparin does not decrease the frequency of infections. Numerous studies indicate that sodium citrate at various concentrations exerts a positive influence on catheter function. However, not all data are in accord. The spill of sodium citrate from the catheter to the systemic circulation is connected with a risk of adverse events. It may be dangerous if the citrate concentration is 46.7%. However, adequate filling of the catheter should prevent such events. Available data indicate that filling of the catheter with a solution of citrate of a concentration of no more than 30% should be safe. Data on 46.7% citrate are not conclusive, so precautions should be taken.