Presentation is loading. Please wait.

Presentation is loading. Please wait.

DURALOCK C Catheter Lock Solution med COMP. Duralock C med COMP protects against catheter related infection.

Similar presentations


Presentation on theme: "DURALOCK C Catheter Lock Solution med COMP. Duralock C med COMP protects against catheter related infection."— Presentation transcript:

1 DURALOCK C Catheter Lock Solution med COMP

2 Duralock C med COMP protects against catheter related infection

3 Duralock C med COMP protects against catheter related infection prevents the formation of biofilm

4 Duralock C med COMP protects against catheter related infection prevents the formation of biofilm prevents catheter clotting  use of thrombolytic agents

5 Duralock C med COMP protects against catheter related infection Literature shows catheter related bacteremia incidence of 3,0 – 7,0 episodes/1.000 cath.days

6 Duralock C med COMP protects against catheter related infection Literature shows catheter related bacteremia incidence of 3,0 – 7,0 episodes/1.000 cath.days TunneledNon tunneled

7 Duralock C med COMP protects against catheter related infection Most cultured microbes: S. aureus Coagulase negative s. aureus S epidermidis Candida albicans E. Agglomerans P. aeruginosa Enterococcus faecalis

8 Duralock C med COMP protects against catheter related infection Consequenses of CRB: Serious complications in the use of catheters

9 Duralock C med COMP protects against catheter related infection Consequenses of CRB: Serious complications in the use of catheters High cost treatment: - catheter exchange - hospitalization (for example for IV treatment with antibiotics

10 Duralock C med COMP protects against catheter related infection Consequenses of CRB: Serious complications in the use of catheters High cost treatment: - catheter exchange - hospitalization (for example for IV treatment with antibiotics Interruption of treatment

11 Duralock C med COMP protects against catheter related infection Consequenses of CRB: Serious complications in the use of catheters High cost treatment: - catheter exchange - hospitalization (for example for IV treatment with antibiotics Interruption of treatment Increasing problem of antibiotic resistance

12 Power of Duralock C med COMP protects against catheter related infection

13 Power of Duralock C med COMP protects against catheter related infection Concentrated Sodium Citrate (23%) for Catheter Lock Stephen R. Ash et al, Hemodialysis International 4:22-31, 2000 Protocol: 40 patients followed for several catheter locking solutions: 1/98-8/98: heparin 5000 units or units 9/98-11/98: 10% sodium citrate (pH 6.5) with 3 mg/mL gentamicin 12/98-3/99: 20% sodium citrate with 3 mg/mL gentamicin 4/99-6/99: 46,7% sodium citrate 7/99-10/99: heparin 5000 or units 11/99-3/00: 23% sodium citrate Study endpoints: The incidence of symptomatic bactaeremia (calculated as the number of episodes per 3000 patient-days) Use of urokinase

14 Power of Duralock C med COMP protects against catheter related infection Infection Rate

15 Power of Duralock C med COMP protects against catheter related infection Heparin 5000 IU/mlTrisodium citrate 30% Nephrol Dial Transplant (2002) 17: 2189–2195 M.C. Weijmer, Y.J. Debets-Ossenkopp, F.J. van de Vondervoort and P.M. ter Wee

16 Power of Duralock C med COMP protects against catheter related infection Nephrol Dial Transplant (2002) 17: 2189–2195 M.C. Weijmer, Y.J. Debets-Ossenkopp, F.J. van de Vondervoort and P.M. ter Wee Disk Diffusion Susceptibility Test

17 Power of Duralock C med COMP protects against catheter related infection Heparin 5000 IU/ml Nephrol Dial Transplant (2002) 17: 2189–2195 M.C. Weijmer, Y.J. Debets-Ossenkopp, F.J. van de Vondervoort and P.M. ter Wee

18 Primary endpoint: Catheter survival Secondary endpoints - infection- bacteremia - exit site infection - thrombosis- flow problems - use of urokinase - side effects- bleeding - thrombocytopenia - systemic reactions after locking Study design Interimanalysis (200 catheters) bacteremia

19 291 hemodialysis catheters citrate 30%heparintotal Catheters tunneled cuffed jugular subclavian femoral untunneled jugular subclavian femoral Catheter days Days per catheter tunneled cuffed untunneled

20 Power of Duralock C med COMP Why protects a citrate solution against catheter related infections?

21 Power of Duralock C med COMP Why protects a citrate solution against catheter related infections? Citrate = combined with citric acid = C 3 H 5 O(COO) 3 3− binds double positive ionized molecules: Ca ++ / Mg ++ Na 3 C 6 H 5 O 7

22 Power of Duralock C med COMP Apart from Mg ++ binding, removal of Ca ++ from the surrounding milieu can be an explanation for the antimicrobial properties of TSC. Ca ++ may regulate several genes responsible for growth and survival of microbes. Holland et al. [19] demonstrated that cell division in E.coli in particular appears to be very sensitive to the level of cellular Ca ++. Weijmer MC, Debets-Ossenkopp YJ, Van de Vondervoort FJ, ter Wee PM: Superior antimicrobial activity of trisodium citrate over heparin for catheter locking. Nephrol Dial Transplant 17: 2189–2195, 2002

23 Power of Duralock C med COMP protects against catheter related infection Nephrol Dial Transplant (2002) 17: 2189–2195 M.C. Weijmer, Y.J. Debets-Ossenkopp, F.J. van de Vondervoort and P.M. ter Wee “We conclude that in our in vitro study using standardized antimicrobial susceptibility tests we demonstrated that TSC 30% was the most potent antimicrobial locking solution and that its hyperosmolality was of minor importance to explain the inhibitory effects of TSC on microbial growth.”

24 Power of Duralock C med COMP protects against catheter related infection Randomized, Clinical Trial Comparison of Trisodium Citrate 30% and Heparin as Catheter-Locking Solution in Hemodialysis Patients Marcel C. Weijmer, Marinus A. van den Dorpel, Peter J.G. Van de Ven, Pieter M. ter Wee, Jos A.C.A. van Geelen, Johannes O. Groeneveld, Brigitte C. van Jaarsveld, Marjon G. Koopmans, Caatje Y. le Poole, Anita M. Schrander-Van der Meer, Carl E.H. Siegert, Koen J.F. Stas; for the CITRATE Study Group

25 Catheter survival heparin TSC P=0.014 days in place 18% med COMP

26 Bacteremia free survival P= heparin TSC days in place 73% med COMP

27 P=0.002P=0.001 Infection related admissions med COMP

28 P=0.35 Mortality overall 0 P= Bacteremia related heparin citrate 30% med COMP

29 Prevents formation of biofilm Duralock C

30 med COMP Prevents formation of biofilm Duralock C Micro organisms

31 med COMP Prevents formation of biofilm Duralock C Biofilm grows under the influence of poly sacharides, produced by micro organisms.

32 med COMP Prevents formation of biofilm Duralock C Biofilm grows under the influence of poly sacharides, produced by micro organisms. Heparin is a poly sacharide combined with an anti thrombin

33 med COMP Prevents formation of biofilm Duralock C Biofilm grows under the influence of poly sacharides, produced by micro organisms. Heparin is a poly sacharide combined with an anti thrombin Heparin induces the growth of biofilm

34 Method: …examined 42 arterial and 26 central venous catheters that had been in place in ICU patients between 1 and 14 days for the presence of bacterial biofilms by scanning electron microscopy, transmission electron microscopy, and a special scraping/sonication bacterial recovery technique. Crit Care Med May;20(5): Biofilms on indwelling vascular catheters, Passerini. L, Lam K, Costerton JW, King EG med COMP Duralock C

35 med COMP Prevents formation of biofilm Duralock C Crit Care Med May;20(5): Biofilms on indwelling vascular catheters, Passerini. L, Lam K, Costerton JW, King EG Conclusion: 1.Extensive biofilm formation on all 42 arterial and 26 central venous catheters. 2.Bacteria within the biofilms on 69% (29/42) of the arterial and 88% (23/26) of the central venous catheters.

36 med COMP Prevents formation of biofilm Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces Robert M. Q. Shanks1, Jennifer L. Sargent1, Raquel M. Martinez1, Martha L. Graber2 and George A. O’Toole1 1Department of Microbiology and Immunology, Dartmouth Medical School, Hanover, NH and 2Department of Medicine, Section of Hypertension and Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA Nephrol Dial Transplant (2006) 1 of 9 doi: /ndt/gfl170 Power of Duralock C

37 med COMP Prevents formation of biofilm Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces Nephrol Dial Transplant (2006) 1 of 9 doi: /ndt/gfl170 This in vitro study demonstrates that heparin alternatives, sodium citrate and sodium EDTA, can prevent the formation of S. aureus biofilms, suggesting that they may reduce the risk of biofilm-associated complications in indwelling catheters. Power of Duralock C

38 med COMP prevents catheter clotting  use of thrombolytic agents Duralock C Catheter related thrombosis is often the cause of low catheter blood flows.

39 med COMP prevents catheter clotting  use of thrombolytic agents Duralock C Catheter related thrombosis is often the cause of low catheter blood flows. Low blood flow  inefficient treatment  low Kt/V

40 med COMP prevents catheter clotting  use of thrombolytic agents Duralock C Catheter related thrombosis is often the cause of low catheter blood flows. Low blood flow  inefficient treatment  low Kt/V Treatment: Expensive thrombolitic agents (TpA, Urokinase, Streptokinase)

41 med COMP prevents catheter clotting  use of thrombolytic agents Power of Duralock C Under influence of Ca++ So...

42 med COMP prevents catheter clotting  use of thrombolytic agents Power of Duralock C Under influence of Ca++ So... Binding Ca++ in the catheter environment, stops the proces of clotting

43 Flow problems getunneld = ongetunneld heparin TSC P=0.754 days in place med COMP

44 Power of Duralock C med COMP Ash SR, et al. ASN 1999 A1375 prevents catheter clotting  use of thrombolytic agents

45 Leakage lock solution Bayes B et al, Nephrol Dial Transpl 1999; 14; 2532 Bleeding complications med COMP Duralock C

46 Power of Duralock C med COMP protects against catheter related infection Sodium citrate for filling haemodialysis catheters “We recommend filling the catheter with sodium citrate 46,7% Bayes B et al, Nephrol Dial Transpl 1999; 14; 2532

47 med COMP Duralock C Bleeding complications Risk of heparin lock-related bleeding when using indwelling venous catheters in haemodialysis, Hüseyin Karaaslan et al, Service de Néphrologie CHU Dupuytren, Limoges, France Nephrol Dial Transpant, (2001) 16:

48 Bleeding complications during citrate-trial P= After insertion P= During follow up heparin citrate 30% Consequences of leakage lock solution med COMP

49 Cornelius J. Doorenbos, Marjo Van den Elsen-Hutten, Margret J. M. Heuven and Jan Hessels, Estimation of trisodium citrate (Citra-LockTM) remaining in central venous catheters after the interdialytic interval, Nephrology Dialysis Transplantation (2): “The injected concentration Citra-Lock tm decreases 30% in the inter dialytic periode in jugular and subclavian catheters. Femoral catheters show a decrease of 90%. DURALOCK C med COMP

50 30% 46,7% 30% Anti microbial protection, Weijmer) DURALOCK C med COMP “The injected concentration Citra-Lock tm decreases 30% in the inter dialytic period in jugular and subclavian catheters. Femoral catheters show a decrease of 90%.

51 Literature reviews: 1. Beathard GA: Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 10: 1045–1049, Weijmer MC, ter Wee PM: Temporary vascular access for hemodialysis treatment. Current guidelines and future directions. Contrib Nephrol 137: 38–45, Costerton JW, Stewart PS, Greenberg EP: Bacterial biofilms: A common cause of persistent infections. Science 284:1318–1322, Raad I: Intravascular-catheter-related infections. Lancet 351: 893–898, Bayes B, Bonal J, Romero R: Sodium citrate for filling haemodialysis catheters. Nephrol Dial Transplant 14: 2532–2533, Karaaslan H, Peyronnet P, Benevent D, Lagarde C, Rince M, Leroux-Robert C: Risk of heparin lock-related bleeding when using indwelling venous catheter in haemodialysis. Nephrol Dial Transplant 16: 2072–2074, Dogra GK, Herson H, Hutchison B, Irish AB, Heath CH, Golledge C, Luxton G, Moody H: Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: A randomized controlled study. J Am Soc Nephrol 13: 2133–2139, Weijmer MC, Debets-Ossenkopp YJ, Van de Vondervoort FJ, ter Wee PM: Superior antimicrobial activity of trisodium citrate over heparin for catheter locking. Nephrol Dial Transplant 17: 2189–2195, Ash SR, Mankus RA, Sutton JM, Criswell ER, Crull CC, Velasquez KA, Smeltzer BD, Ing TS: Concentrated sodium citrate (23%) for catheter lock. Hemodial Int 4: 22–31, Stas KJ, Vanwalleghem J, Moor BD, Keuleers H: Trisodium citrate 30% vs heparin 5% as catheter lock in the interdialytic period in twin- or double-lumen dialysis catheters for intermittent haemodialysis. Nephrol Dial Transplant 16:1521–1522, Twardowski ZJ: High-dose intradialytic urokinase to restore the patency of permanent central vein hemodialysis catheters. Am J Kidney Dis 31: 841–847, Buturovic J, Ponikvar R, Kandus A, Boh M, Klinkmann J, Ivanovich P: Filling hemodialysis catheters in the interdialytic period: Heparin versus citrate versus polygeline: Aprospective randomized study. Artif Organs 22: 945–947, Betjes MG, Van Agteren M: Prevention of dialysis catheterrelatedsepsis with a citrate-taurolidine-containing lock solution. Nephrol Dial Transplant 19: 1546–1551, De Wachter DS, Weijmer MC, Kausylas M, Verdonck PR: Do catheter side holes provide better blood flows? Hemodial Int 6: 40–46, Twardowski ZJ: The clotted central vein catheter for haemodialysis. Nephrol Dial Transplant 13: 2203–2206, FDA Issues Warning on triCitrasol® Dialysis Catheter Anticoagulant.FDA Talk Paper T00-16, Rockville, MD, US Food and Drug Administration, 2000 med COMP Duralock C

52 Heparin –Anticoagulant –Systemic effect –Generates bleeding risks –Promotes bacterial growth, poly sacharide is feed for micro organisms med COMP Duralock C

53 Heparin –Anticoagulant –Systemic effect –Generates bleeding risks –Promotes bacterial growth, poly sacharide is feed for micro organisms –Promotes formation of biofilm med COMP Duralock C

54 Conclusions: med COMP Power of Duralock C 1.Trisodium citrate, in a concentration of at least 30% shows an antimicrobial effect (Weijmer et al) 2.Trisodium citrate 30% shows a decrease of CRB of 75% in a randomized controlled multi centre trial (Weijmer et al). 3.Trisodium citrate 30% doesn’t effect positively on blood flow and use of thrombolytic agents (Weijmer et al) 4.Trisodium citrate 46,7% does show in In vivo studies a decrease in CRB and use of thrombolytic agents like Urokinase. 5.There is leakage of catheter lock solutions in the inter dialytic period, resulting in hight ATTP results, constantly measurable gentamycin levels or decreased trisodium citrate levels. 6.Catheter lock solutions based on antibiotics promote the risk of anti biotic resistance.

55 med COMP DURALOCK C No formation of biofilm Anti microbial effect without anti biotics No drug-resistant bacterial strains No bleeding complications Proven anticoagulant Bio-compatible without systemic effects

56 Action plan- february ליווי אבלואציות במחלקות הנפרולוגיה הצגת הדורה לוק בישיבות הצוות של המחלקות פגישות עם מנהלי מחלקות הנפרולוגיה התחלת אבלואציות במחלקות הנפרולוגיה הצגת הדורה לוק בישיבות הצוות של המחלקות המשך צפייה בפרוצדורות המחלקות האנגיו- שעות 14:00- 17:00

57 Action plan- january מצגת קטטרים לטווח קצר מצגת דורה לוק הצגת דף הסבר דורה לוק המשך צפייה בפרוצדורות המחלקות האנגיו- שעות 8:00-12:00 תיאום פגישות עם הרופאים הרלוונטים המשך צפייה בפרוצדורות המחלקות האנגיו- שעות 8:00-12:00

58 Action plan- march הוצאת דרישות למוצר מול מחלקות הרכש ליווי אבלואציות במחלקות הנפרולוגיה מעקב אחר הזמנות למוצר מול מחלקות הרכש הנפקת הצעות מחיר למנהלי מחלקות הנפרולוגיה הוצאת דרישות למוצר מול מחלקות הרכש השתלבות במחלקות האנגיו הרלוונטיות וחפיפה על הלקוח+ היכרויות עם מנהלי היחידות.

59 med COMP Q & A DURALOCK C


Download ppt "DURALOCK C Catheter Lock Solution med COMP. Duralock C med COMP protects against catheter related infection."

Similar presentations


Ads by Google