Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript

As a consequence..

Catheter Related Bacteremia (CRB) is a major cause of morbidity & mortality

CRB can be associated with catastrophic metastatic complications

e.g. Osteomyelitis, Endocarditis and Septic arthritis.

Issues during Hemodialysis

CITRATE OF CHOICE

Congestion - Hemodialysis set-up

Risks of Bleeding disorders

Prone to Hospital Acquired Infections

*Patients with catheters have a 10-fold excess relative risk of bloodstream infection compared to AV Fistula.

Costly

Citra-Lock

Trisodium Citrate

Safe & Effective

Catheter Lock Solution

Provides antibiotic protection without creating resistance.

Reduces the use of thrombolytic drugs/agents.

E.g. Urokinase, alteplase, reteplase

Inhibits the formation of biofilm.

Reduces bleeding risks.

Keeps its antimicrobial properties in the intradialytic period.

Increases catheter patency

Harmless side effects.

HOW

Trisodium Citrate

WORKS?

Citrate is a calcium binder

By instilling highly concentrated citrate into the lumen, Ca level at lock/blood interface decreases to zero.

Genetically microorganisms need calcium to multiply

When Ca is removed from the local environment, bacterial growth stops

Biofilm consists of a calcium based matrix, removal of Ca also prevents formation of biofilm

Ca is also needed in the clotting cascade, when Ca is removed from the environment, the clotting chain stops.

Clot formation is inhibited.

EUROPEAN GUIDELINES

Hemodialysis Unit

Citra-lock

STANDARD ANTICOAGULATION

Anticoagulation in routine hemodialysis consists of a standard dose of heparin given as a bolus at the start of the dialysis treatment, with a mid-treatment dose to maintain suitable anticoagulation.

Advantages

HEPARIN

Safe & Effective

Catheter Lock Solution

ANTI-BIOFILM- Citrate binds to calcium.

ANTI-COAGULANT- zero use of Urokinase (thrombolytic agent).

ANTIMICROBIAL- significant decrease in incidence of symptomatic bacteremia.

NEEDLE-FREE- Drip free and with Luer connector.

Polysaccharide combined with an Anti-Thrombin

Widely used despite lack of evidence to support efficacy and safety

Heparin can:

Cause unintentional systemic anticoagulation even when correct volume is given

Interfere with lab assessments of clotting

HITS (Heparin-induced thrombocytopenia)

HIA (Heparin-induced antibodies)

Increase bleeding risks in uremic patients

Actually enhance staphylococcal biofilm formation

As a result..

For Patients:

No need for antibiotic prophylaxis means No need for additional medication expense.

Prevents Catheter-related Thrombosis means minimizing risks of bleeding during hemodialysis.

For Healthcare providers:

Easy to administer.

COLORIZATION

ADMINISTRATION INSTRUCTIONS

FREQUENTLY ASKED QUESTIONS

Citra-Lock™ has a thrombolytic effect, it chelates clotting parts and biofilm.

This may result in a pink colorization of the extension parts of the catheter, specially in catheters which have been used for longer periods

Leakage of Citra-Lock™ is also a reason for the colorization.

Pre-dialysis (maintain asepsis)

Prior to initiation of dialysis, Citra-Lock™ should be aspirated and discarded and catheter flow assessed according to local policy.

Post-dialysis (maintain asepsis)

Flush each catheter lumen with 0.9% saline as per local policy.

Using a 2.5 ml syringe draw up the exact volume of Citra-Lock™ for each lumen

Inject slowly over 5-10 seconds.

SIDE EFFECTS

Harmless and transient

Metallic taste (dygesia) or tingling in the fingers (paresthesia)

Sign that the catheter lock volume was overdosed

Decreasing the volume with 0.1 mL for the next instillation will solve this problem in most cases

If used according to the instructions in volumes suitable to catheter lumens, no reason to expect systemic effects from such a small volume of citrate.

Learn more about creating dynamic, engaging presentations with Prezi