Exit of catheter lock solutions from double lumen acute haemodialysis catheters - an in vitro study

Abstract

Background. Double lumen dialysis catheters are routinely heparin or citrate 'locked' to maintain patency. Heparin lock-related bleeding episodes and antibiotic lock-related toxicity have been reported. The aim of this study is to quantify the amount of leak during 'lock' procedures and to compare leakage for different double lumen dialysis catheters. Methods. In an experimental, in vitro study at a University research laboratory, five different double lumen dialysis catheters were tested using three different lock volumes. Results. Using the catheter flush volume, leak ratios for Flexxicon II 15 cm and 20 cm catheters were greater than that seen in the Arrow 16 cm catheter (P < 0.05). Using 20% less than the catheter flush volume, the Flexxicon II (TM) 20 cm catheter had greater leak than the Duo-flow 15 and 20 cm catheters and Arrow 16 cm catheter (P < 0.05). The Flexxicon II (TM) 15 cm catheter had greater leak than the Duo-flow 15 cm and Duo-flow 20 cm catheters with 20% less locking volume (P < 0.05). Using 20% greater than the catheter flush volume, the Duo-flow 20 cm catheter had significantly less leak ratio than the Flexxicon II (TM) 20 cm catheter (P < 0.05). There were no other significant differences in leak ratios between the catheters. Conclusion. All double lumen dialysis catheters we tested have a substantial amount of leak even when the catheter 'lock' volumes were used, and leak ratio increases significantly with 20% overfill. There is a leak even when using 20% less 'lock' volume. The amount of leak can be clinically important and may explain the reports of bleeding episodes after heparin lock and antibiotic toxicity after antibiotic and anticoagulant combination lock. Some devices have lower leak ratios than others, likely related to catheter design.