Clinical Study Of Early Leakage Of Venous Catheter Sealing Fluid In Hemodialysis Center

Objective :To observe the early leakage rate of the central venous catheter sealing fluid in hemodialysis patients,and to provide a basis for the sealing strategy for patients who rely on central venous catheters to maintain hemodialysis.Methods: 1.A total of 30 patients who underwent central jugular vein catheterization in the right internal jugular vein for the first time in the Department of Nephrology at Wuhan First Hospital from June 2017 to December 2017 were selected as the study object.After catheterization,3125 IU/mL heparin sodium was used to seal the catheter in nominal volume.Blood samples of catheter A and peripheral blood B were taken 30 s and 10 min after sealing,and blood samples were collected for blood analysis and plasma heparin determination.Then the direct and indirect methods were used to calculate the heparin leakage.2.According to the hematocrit(Hct)of A and B-like specimens,the volume of heparin required to dilute the hematocrit(Hct a/Hct b)in the volume to be extracted was calculated,and then the heparin leakage rate was calculated.3.The heparin concentration was deduced by direct measurement of anti-Xa activity,and the early leakage rate of the catheter was calculated based on the heparin concentrations of A and B samples.4.24 hours after sealing the catheter,observe whether the patient has catheterization and venous end of the lumen coagulation,repeated blood pumping before dialysis,blood flow is not smooth or blood flow,but the catheter blood flow can not maintain hemodialysis;whether there is partial oozing of the puncture site,Bleeding and other parts of the bleeding,namely: oral teeth;subcutaneous;digestive tract;respiratory tract;cerebral hemorrhage;hematuria and other phenomena.Result1.The regression equation between heparin concentration(X)and anti-Xa activity(Y)is: Y=-14.423+1.107 X.2.After injecting the sealing fluid in the scalar volume(2.3 mL)for 30 s,the leakage rate of the catheter sealing fluid was measured by indirect method(22.94% ±2.36%).The direct method was used to determine the leakage rate of 23.9% ± 2.6%.The difference was not statistically significant(P>0.05).3125 IU/mL heparin sealing fluid sealing tube 10 min later,the indirect method measured 35.18%±3.8% in the catheter group;the direct method showed a leakage rate of 36.9%±3.13%.There was no significant difference between the two methods(P>0.05).The catheter leakage rate(early leakage rate)was higher than the catheter leakage rate(immediate leakage rate)after 10 minutes after sealing the tube,and the difference was statistically significant(P<0.001).3.After 24 h of sealing of 3125 IU/mL heparin scalar volume,there was no catheter blockage and bleeding.ConclusionThe leakage rate immediately after sealing with 3125 IU/mL heparin(sealed tube for 30s)was 22.94%±2.36%(indirect method),23.9%±2.6%(direct method);the early leak rate(10min sealed tube)was 35.18% ±3.8%(indirect method),36.9%±3.13%(direct method).Both direct and indirect calculation methods can be used to evaluate the leakage of the sealing fluid,and there are no significant differences between the two methods of calculation.