The Influencing Factors And Treatment Of Long-term Central Venous Catheters Dysfunction

Objective: To investigate the factors influencing dysfunction of long-term CVC for MHD patients and the treatment of catheter dysfunction,so as to prevent and deal with it effectively,and then extending the duration of catheter and improving the quality and survival rate for MHD patients.Methods: We selected the ESRD(End stage renal disease)patients of our hospital who have done the CVC surgery in the period of June 2013 till June 2016.selection criteria :1.ESRD patients 2.fully hospital data 3.duration of catheter for more than 3 months 4.normal function of coagulation and platelet 5.no primary polycythemia.Excusion criteria: dysfunction of catheter occurs within 3 months after placed(definition of Dysfuction: blood flow rate less than 200 ml/min;arterial pressure lower than 250 mm Hg or venous pressure higher than 250 mm Hg when pump blood flow rate is 200 ml/min).Complete the information of participants and process the needed data concluding: sex,age,primary disease,time,location;history of catheter placing or not,catheter dysfunction happens or not,meanwhile,other date(including hemoglobin,hematocrit,platelet,albumin,globulin,total protein,cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,fibrinogen,low density lipoprotein / high density lipoprotein)is also completed.Patients were divided into group A(CVC implantation from June 1,2015 to May 31,2016),group B(CVC implantation from June 1,2014 to May 31,2015)and group C(CVC implantation from June 1,2013 to May 31,2014).Each group is divided into two subgroups by catheter function(1st subgroup:normal function,2nd subgroup: dysfunction).We compare group A,group B and group C patients by sex,ages,primary diseases,catheters' position,wheather or not do the CVC surgery formerly,and hemoglobin,hematocrit,platelet,albumin,globulin,total protein,cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,fibrinogen,low density lipoprotein / high density lipoprotein.Then we take measures to patients with dysfunctional,it can divided into four steps:take the haperin out of the catheter and then discard it;100,000 U urokinase plus 12500 u heparin sodium injection(2ml)dubbed 25,000 U / ml urokinase;inject liquid in accordance with the identification volume of the catheter port;close the catheter with heparin cap.Judgment on efficiency of thrombolysis: injecting and aspiration the blood by 10 ml syringe without any resistance and blood flow rate higer than 200ml/min is regarded as success in thorombolysis after treatment about 20 to 30 minutes.If it doesn't work,2-3 times should be repeated as previous steps.thrombolytic failure is defined after 3 times.Results: 1.A total of 147 patients were enrolled in the standard.A group of 43 patients,including A1 group of patients in 39 cases(90.70%),A2 group of 4 cases(9.30%).There was no significant difference between the two groups in the ages,sex composition,primary disease,catheterization,hemoglobin,hematocrit,platelet,albumin,total protein,triglyceride,high density lipoprotein,fibrinogen,and low density lipoprotein / high density lipoprotein(P <0.05).There were statistically significant differences(P <0.05)between the two groups in the history of catheterization,globulin,total cholesterol and low density lipoprotein.2.B group of 57 patients,including B1 group of patients in 50 cases(87.72%),B2 group of 7 cases(12.28%).There was no significant difference between the two groups in the ages,sex composition,primary disease,catheterization,the history of catheterization,hematocrit,platelet,albumin,globulin,total protein,triglyceride,high density lipoprotein,fibrinogen,and low density lipoprotein / high density lipoprotein(P <0.05).There were statistically significant differences(P <0.05)between the two groups in hemoglobin,total cholesterol and low density lipoprotein.3.C group of 47 patients,including C1 group of patients in 33 cases(70.21%),C2 group of 14 cases(29.79%).There was no significant difference between the two groups in the ages,sex composition,primary disease,catheterization,the history of catheterization,hemoglobin,hematocrit,platelet,albumin,globulin,total protein,triglyceride,total cholesterol,low density lipoprotein,high density lipoprotein,fibrinogen,and low density lipoprotein / high density lipoprotein(P <0.05).There were statistically significant differences(P <0.05)between the two groups in the primary disease(diabetic nephropathy).4.There was significant difference between group A2 and group C2(P <0.05).There was no significant difference between group A2 and group B2(P> 0.05).But there was no significant difference between group A2 and group B2(P?0.05).5.Low density lipoprotein(LDL)is an independent risk factor for long-term CVC dysfunction in group A.6.The success rate of thrombolysis was 23(92.00%)for 25 patients with long-term CVC dysfunction in our hospital who had urokinase(2.5 000 U / ml)+ heparin(3125 U / ml).Conclusion: 1.The longer the retention time,the higher the rate of catheter dysfunction.2.Hemoglobin,globulin,low density lipoprotein,total cholesterol level,previous history of catheterization and whether the primary disease is diabetic nephropathy are a long-term CVC dysfunction factors,and low-density lipoprotein for the catheter 3 months to one year long-term adverse effects of CVC dysfunction.