Abstract
The Department of Health and Social Care has recently published a National Patient Safety alert for the shortage of alteplase and tenecteplase injections. It was advised that all limited stock be prioritised for the management of acute ischaemic stroke, given the lack of alternative treatment. For all other indications, including haemodialysis line locking, an alternative to alteplase, such as TauroLock Urokinase should be used. The aim of the project was to evaluate the impact of changing paediatric haemodialysis line locks from the standard practice recombinant tissue plasminogen activator alteplase to the urokinase-type plasminogen activator TauroLock Urokinase. The aim of the project was to determine the cost implication of switching therapy, the incidence of line infections and thrombotic occlusions and the subsequent requirement for catheter line replacements to understand patient safety outcomes related to this service change.
Data was retrospectively collected on the use of alteplase as a haemodialysis line lock from the past 6 months between the 17th of February 2022 to the 17th August 2022 and prospectively on the use of TauroLock Urokinase in the next 6 months between the 17th of August 2022 to the 17th of February 2023. The Scottish Electronic Renal Patient Record (SERPR) software was used to collect clinical information for each patient regarding the date their catheter was inserted, the type of catheter inserted, the type of line lock solution used prior to supply constraints, how many times the patient receives haemodialysis a week, if the patient has required to have their line replaced, the cause of the line replacement and the requirement for alteplase infusions potentially indicating the presence of a intraluminal clot. Clinical Portal was used to access patient demographics and inpatient records/HEPMA reports in relation to catheter related line infections to collect data on the requirement for antibiotic therapy and duration of treatment.
From the data collected, the incidence of thrombotic occlusions was found to be lower whilst using alteplase as a haemodialysis line lock in comparison to TauroLock Urokinase in the population studied. However, TauroLock Urokinase was more effective at preventing the incidence of line infections. In patients receiving TauroLock Urokinase as haemodialysis line locks, only two patients were admitted with suspected infection but neither required antimicrobial treatment. In comparison, in patients receiving alteplase to lock their haemodialysis lines, all three patients were admitted with line infections and required antimicrobial therapy to eradicate the infection. By switching practice from alteplase to TauroLock Urokinase, the institute has saved approximately £47,897.60 within this 6 month period alone.
This project found that TauroLock Urokinase reduced the need for antibiotic use in patients with haemodialysis line infections when compared to the tissue plasminogen activator alteplase. TauroLock Urokinase has a significant cost reduction in comparison to alteplase and similar efficacy. The benefit is offset partly by a greater need for thrombolytic therapy due to increased thrombotic occlusions. A formulation with better anticoagulant properties is needed for haemodialysis patients.
