الفهرس 
Hemodialysis and Vascular accessOnly 14 pages are availabe for public view
 |  | from | 135 |  |  |
| | | from | 135 | | |
Abstract
Patients with ESRD on regular hemodialysis show high level of morbidity and mortality caused mainly by cardiovascular complications followed by infections.
Good vascular access is mandatory for performing adequate hemodialysis, including A-V fistula which is considered the best option followed by A-V graft and finally central venous catheters (tunneled and non-tunneled).
Catheter related infections are common especially with temporary non-tunneled hemodialysis catheters. Catheter lock solutions are important to maintain adequate catheter performance and decrease rate of infections and superimposed inflammatory condition.
Our study was done in hemodialysis unit of Ain-Shams university hospital that included 60 patients on regular hemodialysis at time of insertion of temporary hemodialysis catheter. Patients were divided into 2 groups 1st group received taurolidine +citrate +500 IU heparin as a lock solution ,while 2nd group received unfractionated heparin as a classic lock solution.
All patients were subjected to full history taking with special highlight on: (age, gender, etiology of ESRD, hemodialysis duration).
CBC, hsCRP, IL-6 were measured at the start and after one month of catheter insertion.in addition to cultures when CRBSI is suspected.
Blood flow rate, URR were measured weekly in both groups to assess catheter performance.
On comparison between both groups as regard levels of inflammatory markers before and after one month of catheter insertion, we found a significant difference in favor of group 1 indicating lower levels of inflammation.
Our results also showed a better catheter performance in group 1 that was proved by better blood flow measured over dialysis sessions in association with better results for URR, a significant DROP in values of blood flow and URR from 1st to 4th week was observed in group 2 with classic heparin lock.
During follow-up of patients one patient from 1st group developed catheter related blood stream infection, while 9 patients from 2nd group developed catheter related blood stream infection(3 patients in 3rd week and 6 patients in 4th week),this may be due to antimicrobial effect of taurolidine that prevent biofilm formation.
In conclusion we found that using TCHLS as a catheter lock instead of classic heparin lock has a better impact on catheter performance, incidence of CRBSI and levels of inflammatory markers.