非隧道式血液透析導管封管液的最新進展

Lock solution for non-tunneled hemodialysis catheter:recent advances

目的探討目前非隧道式血液透析導管封管液的最新進展。方法通過檢索Ovid MEDLINE,PubMed和Joanna Briggs數據庫以及手動檢索方式檢索,針對不同非隧道式血液透析導管的封管液之研究文獻,經進一步檢閱評級,共採納6篇文獻符合要求。結果研究文獻指出非隧道式血液透析導管使用新型封管液(如檸檬酸鹽液及抗菌藥物等)在導管相關性感染優於使用傳統肝素封管液。但納入的研究中未發現兩者在穿刺部位感染和導管通暢性存在顯著差異。然而,由於文獻中包括不同濃度的檸檬酸鹽液及和抗菌劑的組合,因此新型封管液的功效和安全性仍不能確定。結論檸檬酸鹽液在導管相關性感染、穿刺部位感染和導管通暢性可能優於傳統肝素封管液。

Objective This literature review aimed to identify the recent advance on the effectiveness of different non-tunneled hemodialysis catheters(NTHCs)lock solutions.Methods A literature search was conducted to achieve available articles published from 2010 to 2020 focusing on the latest advancements for the lock solution for NTHCs.Ovid MEDLINE,PubMed,and Joanna Briggs Institute Database were searched,and manual searching of bibliographies was also adopted to enhance the searching.Results Based on the reviewed studies,three primary outcomes were discussed in the light of catheter-related bloodstream infection(CRBSI),exit-site infection,and catheter patency,respectively.The literature suggested a significant difference between heparin and novel lock solution such as citrate with antimicrobials,as a catheter lock solution in terms of the survival duration of CRBSI in patients with NTHCs in critically ill patients.No significant difference in the exit-site infection and the preservation of catheter patency was found in the included studies.However,due to the variation of citrate concentration and the combination of antimicrobials,the efficacy and safety of antimicrobial lock solutions remained unclear.Conclusion Different citrate lock solutions were likely superior to the conventional heparin lock solution in terms of CRBSI,exit-site infection,and maintenance of catheter patency.