Catheter outcomes in the short-term inpatient setting: a controlled quality improvement study comparing citrate and heparin lock.

Heparin and citrate are used as catheter lock solutions to reduce risk of catheter dysfunction and infection in hemodialysis. There is a paucity of data comparing these two locks in the short-term, inpatient setting. We compared the efficacy of 2.2% acid citrate dextrose (ACD) versus 5000 U/ml heparin as catheter lock in the inpatient setting. The study was conducted at two sites within our system, with ACD locks used at site 1 and heparin locks at site 2. We assessed catheters for catheter dysfunction and infection. Both nontunneled dialysis catheters (NTDC) and tunneled dialysis catheters (TDC) were evaluated. We studied 250 catheters and 139 met inclusion criteria: 90 catheters in the ACD group and 49 in the heparin group. ACD had superior outcomes for NTDC; event rate was 0.052 for NTDC/ACD and 0.125 for NTDC/heparin (p = 0.032). There was no difference for TDC. Univariate (odds ratio [OR]: 1.88, confidence interval [CI]: 0.931, 3.82) and multivariate (OR: 1.35, CI: 0.64, 2.87) analyses demonstrated a trend toward increased odds of event with heparin. Catheter lock with 2.2% ACD has lower risk of catheter dysfunction as compared with that of 5000 U/ml heparin in the short-term inpatient setting in NTDC and similar risk in TDC.

Iatrogenic graft to vein fistula (GVF) formation associated with synthetic arteriovenous grafts.

The prevalence of fistulous connection between arteriovenous graft (AVG) and an adjacent vein resulting in graft-vein fistula (GVF) formation is not established. AVG venous outflow stenosis along with repeated and traumatic cannulation is likely major contributing factor of this complication. Detection and resolution of venous outflow stenosis may be the only needed intervention. We report a series of eight cases with GVF formation between AVG and adjacent veins. Awareness of this complication and intervention to relieve stenotic lesions may result in improved AVG survival.