Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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Gewählte Publikation:

Schenk, P; Rosenkranz, AR; Wolfl, G; Horl, WH; Traindl, O.
Recombinant tissue plasminogen activator is a useful alternative to heparin in priming quinton permcath.
Am J Kidney Dis. 2000; 35(1):130-136 Doi: 10.1016/S0272-6386(00)70311-8
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Co-Autor*innen der Med Uni Graz: Rosenkranz Alexander
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Abstract:: Soft, cuffed, implantable central venous catheters such as the Quinton Permcath (Quinton Instrument Co, Seattle, WA) are increasingly used as permanent access in patients with end-stage renal disease. Their major limitations, besides infection, are thrombosis and inadequate blood flow. To prevent those complications, heparin is conventionally used for priming the Quinton Permcath between dialysis sessions. In this study, we compared recombinant tissue plasminogen activator (rTPA) with heparin for priming the Quinton Permcath in a prospective, randomized, crossover design. Twelve patients were randomly assigned to receive 2,000 IU of heparin or 2 mg of rTPA injected into each catheter lumen at the end of each dialysis session over a period of 4 months, followed by a switch to the other substance. Blood flow rate (flow), venous pressure (VP), and arterial pressure (AP) were monitored at each dialysis session hourly. Flow was significantly greater (P = 0.0001) with rTPA (mean +/- SD, 237.7 +/- 18.1 and 231.6 +/- 12.4 mL/min for the first and second 2 months, respectively) compared with heparin (208.5 +/- 10.1 and 206.9 +/- 14.2 mL/min for the first and second 2 months, respectively). VP was significantly less (P = 0.0001) with rTPA (135.4 +/- 8.2 and 140 +/- 15.2 mm Hg for the first and second 2 months, respectively) compared with heparin (160.5 +/- 16.1 and 159.2 +/- 20.7 mm Hg for the first and second 2 months, respectively). AP was significantly greater (P = 0.0002) with rTPA (-113.5 +/- 11.8 and -115.9 +/- 12.7 mm Hg for the first and second 2 months, respectively) compared with heparin (-136.5 +/- 23.3 and -134.7 +/- 25.8 mm Hg for the first and second 2 months, respectively). In addition, fewer complications (flow problems, clotting, and need for fibrinolysis) occurred in the rTPA period. These results show that rTPA is superior to heparin for priming the Quinton Permcath between hemodialysis sessions and can be used as a valuable alternative to conventional heparin in selected patients.
Find related publications in this database (using NLM MeSH Indexing): Aged -; Arteriovenous Shunt, Surgical -; Blood Flow Velocity - drug effects; Catheters, Indwelling -; Cross-Over Studies -; Female -; Fibrinolysis - drug effects; Graft Occlusion, Vascular - blood Graft Occlusion, Vascular - prevention and control; Heparin - administration and dosage Heparin - adverse effects; Heparin, Low-Molecular-Weight - administration and dosage Heparin, Low-Molecular-Weight - adverse effects; Humans -; Kidney Failure, Chronic - therapy; Male -; Middle Aged -; Prospective Studies -; Renal Dialysis -; Tissue Plasminogen Activator - administration and dosage Tissue Plasminogen Activator - adverse effects
Find related publications in this database (Keywords): Permcath; hemodialysis (HD); catheter performance; heparin; recombinant tissue plasminogen activator (rTPA)