Authors: (including presenting author): :
Lin WT(1), Chow YL(1), Hui CF(1), Wong PK(1), Tsang WY(1), Wong SH(1)
Affiliation: :
(1) Renal Unit, Department of Medical & Geriatrics, United Christian Hospital
Keyword 1: :
Tego needleless connector
Keyword 2: :
Reduces anticoagulation-related risk
Keyword 3: :
Mitigate Heparin-Related Risks in Haemodialysis Care
Introduction: :
Heparin locking is commonly used to maintain haemodialysis (HD) catheter patency, however, a Serious Untoward Event (SUE) occurred when heparin was unintentionally injected into a patient, resulting in a life-threatening situation. To prevent recurrence and improve safety, the UCH Renal Unit implemented neutral-valve closed-system needleless connectors (Tego needleless connectors) with normal saline flushing to maintain HD catheter patency.
Objectives: :
1. To improve patient safety and prevent recurrence of catheter injection–related incidents. 2. To reduce risks associated with improper use of anticoagulation therapy in HD catheter care.
Methodology: :
A single-centre, prospective pre–post study was conducted in the UCH Renal Unit from July 2022 to April 2023. All eligible HD patients were transitioned from heparin locking to Tego needleless connectors with normal saline flushing in two phases: • Phase 1: Patients with temporary dual-lumen HD catheters used Tego connectors for three months. • Phase 2: Patients with permanent (PermCath) catheters used Tego connectors for three months. A structured observation chart was developed to capture indicators of catheter patency at each HD session and was recorded by responsible nurses. The size and length of clots were classified as: no clot (0), < 0.5cm (+), 0.5-1cm (++), >1-1.5cm (+++), >1.5-2cm (++++). Prospective data during the Tego connector use with normal saline flushing (intervention) were compared with the same patients’ historical data when heparin locking was used (control). Two outcomes were evaluated: Primary outcome: Comparative clot-size measurements aspirated from the arterial and venous catheter limbs (pre-intervention heparin lock compared to post-intervention Tego connector with normal saline lock). Secondary outcomes: Catheter patency outcomes, including incidence of catheter blockage and overall effectiveness of Tego with normal saline locking compared with heparin locking.
Result & Outcome: :
Results: A total of 80 patients were included (temporary HD catheters: n = 40; permanent HD catheters: n = 40). The data for dual lumen catheters was not formally compared for pre-post test analysis, as no dual lumen catheter was used for more than 3 months. Only permanent HD catheters will be used for the primary comparative (pre–post) analysis (N = 40). The arterial-limb aspirated clot size was typically graded 3–4+ during heparin locking, with a mean score of 1.67. The clot size was graded 4+ after implementation of Tego connectors with normal saline flushing, with a mean score of 2.05 (P = 0.000). For the venous limb, aspirated clot size was graded 4+ during heparin locking (mean score 1.94) and remained 4+ following Tego connectors with normal saline flushing (mean score 2.06; P = 0.090). No clinically significant clot formation was observed. No HD catheters were blocked during the intervention period, and catheter patency was maintained. Conclusion: Replacing heparin locking with Tego needleless connectors and normal saline flushing maintained HD catheter patency and provided a safe and effective alternative to heparin locking. This intervention reduces the risk of anticoagulation-related complications, enhances patient safety and supports safer haemodialysis catheter care.
