En el sellado del catéter venoso central en hemodiálisis, ¿presenta el uso de citrato respecto al uso de heparina menos complicaciones de infección? Una revisión de la literatura

Abstract

Introduction: Heparin is the standard anticoagulant drug commonly used in hemodialysis services for the permeabilization of central venous catheters. Although it has risks like bleeding. Catheter-associated infection, either by colonization of the catheter or bacteraemia is the most important event and the second cause of mortality following cardiovascular disease in the hemodialysis patient. In this sense, citrate use is being presented as an alternative for central venous catheter sealing because it has both local and antimicrobial anticoagulant properties and could be more efficient in preventing or reducing catheter-associated infection. Objectives: To identify which sealing anticoagulant of the central venous catheter, heparin or citrate, presents less complications of catheter-associated bacteremia and colonization of the catheter. Material and Method: A bibliographic search was performed through the EBSCOhost (Academic Search Premier, CINAHL) and PubMed, IME, Ibecs, LILACS, CUIDEN, Scopus and Cochrane Library databases, with the final selection of 15 documents after the application of search limits, removal of duplicates and the application of the inclusion/exclusion criteria. The most relevant and current results available in the scientific literature showed some variability, both in anticoagulant concentrations and in the incidence of infection. Results and Discussion: Numerous evidence on catheter-associated bacteremia, both in relation to the concentration and the combination of the sealed anticoagulant, indicates that 4% citrate could reduce the incidence of bacteremia. However, antimicrobial-associated citrate is more effective in preventing bacteremia than sodium heparin or exclusive citrate. Conclusions: Although the use of exclusive sodium citrate does not present clear advantages in the complications of catheter-associated infection with sodium heparin, the benefits are shown at low (4%) or moderate (30%) concentrations, especially when combined with antibiotics. Even so, the association of citrate with antibiotics should be studied according to patient comorbidity, recurrence of infection and antibiotic resistance.