An Evidence-Based Study On The Effect Of Different Sealing Fluids On Hemodialysis Of Central Venous Catheter

Objective:In this study,clinical practice guidelines(CPG)related to sealing fluid of hemodialysis central venous catheter were collected at home and abroad,and the types of sealing fluid recommended by CPG were analyzed and compared.To evaluate the effect of different sealing fluids on hemodialysis of central venous catheters by network Meta-analysis,rank the relative advantages and disadvantages,and obtain the relative optimal tube sealing solution.Methods:(Ⅰ)Comparative analysis of guidelines recommendations for sealing fluid of hemodialysis central venous catheter: Pub Med,Web of science,EMBASE,Cochrane,CINAHL,Sino Med,CNKI,Wan Fang,GIN,Up To Date,WHO,BMJ,NGC,NICE,Nephrology Society,central venous catheter access related websites were searched.To analyze and compare the recommendations of CPGS related to sealing fluid for hemodialysis central venous catheter.(Ⅱ)Evaluation of the effect of different sealing fluids on central venous catheter hemodialysis based on network meta-analysis and systematic review method: By searching Chinese and English databases,the search time was limited to the establishment of the database to October 31,2022,and the literature was screened according to the inclusion and exclusion criteria.Ro B2 was used to assess the bias risk of RCTs inclusion,and Stata 16.0 and R4.1.2 were used to analyze the effects of different sealing fluids on central venous catheter hemodialysis.Results:(Ⅰ)Comparative analysis of guidelines recommendations on sealing fluid for hemodialysis central venous catheter:Six CPGS were included from China(3 CPGS),the United States(1CPG)and Spain(2 CPGS),published in 2022,2021,2019(2 CPGS),2018,and 2017,respectively.All six CPGS contained the type and concentration of sealing solution for central venous catheter hemodialysis,and only three CPGS were weakly recommended,while the others were not recommended,indicating that the CPG recommendations were inconsistent.(Ⅱ)Effect evaluation of different sealing fluids on central venous catheter hemodialysis: based on network meta-analysis and systematic review methods(1)Dialysis blood flowThe effect of tube sealing fluid on dialysis blood flow from best to second: 5000U/m L urokinase once /2 weeks,the rest 6250U/m L heparin >3125U/m L heparin +5000U/m L urokinase > 25000U/m L urokinase once /2weeks,the rest were 3125U/m L heparin > 10000 U/m L urokinase once /2weeks,the rest 6250U/m L heparin > urokinase 5000U/m L > 50000U/m L urokinase once /1 week,the rest 6250U/m L heparin > 6250U/m L heparin >3125U/m L heparin > 500U/m L heparin.(2)Urea clearance indexThe sealing liquid in the urea clearance index from best to second:5000U/m L urokinase once /2 weeks,the rest 6250 U/m L heparin > 10000U/m L urokinase once /2 weeks,the rest 6250 U/m L heparin > 50000U/m L urokinase once/week,the rest 6250 U/m L heparin > 6250 U/m L heparin.(3)Incidence of catheter-related infectionThe sealing solution in the prevention of CRI incidence from best to second: 10000U/m L urokinase once /1 week,the rest 5000 U/m L heparin >4% EDTA tetra sodium > 30% sodium citrate > C-MB-P > 4% sodium citrate > rt-PA(1 mg per cavity)once /1 week,the rest 5000 U/m L heparin >70% ethanol once /1 week,the rest 5000U/m L heparin > 4.67% sodium citrate > 5000U/m L heparin > 1.35% taurolidine and 4% sodium citrate >26% Na Cl and 500U/m L heparin.(4)Incidence of catheter dysfunctionThe incidence of tube sealing solution in preventing catheter dysfunction from best to second : 12500U/m L urokinase > 10000 U/m L urokinase once /2 weeks,the rest 6250 U/m L heparin > 5000U/m L urokinase once /2 weeks,the rest 6250U/m L heparin > 500U/m L heparin > 6250U/m L heparin > 3125U/m L heparin > 1250U/m L heparin > 2500U/m L urokinase >2500U/m L heparin.Conclusions:1.At present,the recommended number of CPGS containing the sealing solution of hemodialysis central venous catheter is small,and the recommended opinions are inconsistent.2.5000U/m L urokinase once /2 weeks,the remaining 6250 U/m L heparin sealing solution is relatively optimal for improving urea clearance index and maintaining dialysis blood flow.3.10000U/m L urokinase once a week and the remaining 5000 U/m L heparin sealing solution have the best prevention effect on CRI.4.12500U/m L urokinase sealing solution has the best effect on preventing catheter dysfunction.