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International Journal of Nephrology
Volume 2012 (2012), Article ID 170857, 10 pages
http://dx.doi.org/10.1155/2012/170857
Review Article

Minimizing Hemodialysis Catheter Dysfunction: An Ounce of Prevention

1University of Cincinnati, Cincinnati, OH 45267-0585, USA
2Faculty of Medicine, University of Toronto, University Health Network-Toronto General Hospital, Toronto, ON, Canada M5G 2C4
3University of Texas Southwestern Medical Center, Dallas, TX 75390-8856, USA
4Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada N6A 5W9
5Division of Nephrology, Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5W9
6Nephrology Associates of Central Florida, Lake Mary, FL 32746, USA
7Albert Einstein College of Medicine, Bronx, NY 10467, USA

Received 29 September 2011; Accepted 10 October 2011

Academic Editor: Alexander Yevzlin

Copyright © 2012 Timmy Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The maintenance of tunneled catheter (TC) patency is critical for the provision of adequate hemodialysis in patients who are TC-dependent. TC dysfunction results in the need for costly and inconvenient interventions, and reduced quality of life. Since the introduction of TCs in the late 1980s, heparin catheter lock has been the standard prophylactic regimen for the prevention of TC dysfunction. More recently, alternative catheter locking agents have emerged, and in some cases have shown to be superior to heparin lock with respect to improving TC patency and reducing TC-associated infections. These include citrate, tissue plasminogen activator, and a novel agent containing sodium citrate, methylene blue, methylparaben, and propylparaben. In addition, prophylaxis using oral anticoagulants/antiplatelet agents, including warfarin, aspirin, ticlodipine, as well as the use of modified heparin-coated catheters have also been studied for the prevention of TC dysfunction with variable results. The use of oral anticoagulants and/or antiplatelet agents as primary or secondary prevention of TC dysfunction must be weighed against their potential adverse effects, and should be individualized for each patient.