Recent article in the NEJM - January 27, 2011
Compared with unfractionated heparin 3X/week, the use of rt-PA (recombinant tissue plasminogen activator) as a catheter locking solution once a week (and heparin 2x/week), significantly reduces catheter malfunctions and bacteremia (20% vs 35% for malfunction, hazard ratio of 1.91, p=0.02; and 4.5% vs 13% for bacteremia, HR of 3.3, p=0.02 - very small numbers in comparisons). While upfront, TPA is more expensive ($1795 vs $195), the cost of caring for complications is $156 vs $582 and incremental cost is $1173 vs $13,956.......in the Canadian Healthcare system -
Would expect the costs to be much higher in the US system. A much needed analysis using their data set will put that issue to rest.
The inclusion criteria had the patients using the white plastic tube of death for more than 6 months to be eligible - seems incredibly long - all efforts in the hands of providers at all levels should be to eliminate exposure to catheters, or at the very least minimize it.
