Epinephrine-anesthesia reduces catheter bleeding
Patients who receive a tunneled hemodialysis catheter (THC) often experience pericatheter bleeding (PB).
This not only complicates the securing of the THC, but can also loosen the adhesive catheter dressing and delay wound healing, warn radiologists at the Istanbul Training and Research Hospital in Turkey (Mutlu IN et al, Regional anesthesia with epinephrine‐containing lidocaine reduces pericatheter bleeding after tunneled hemodialysis catheter placement, Hemodial Int 2018; doi: 10.1111/hdi.12686). In the present study, the authors investigated whether the use of epinephrine-containing local anesthetics could reduce superficial PB after THC placement. The result: This approach may not only reduce superficial PB, but also improve patient comfort.
The study included 46 patients receiving local analgesia during THC placement: 22 received a local anesthetic mixture with prilocaine (group 1), 24 received a mixture with lidocaine which contains epinephrine (group 2). Compared to group 1, patients of group 2 had significantly reduced PB (p = 0.003), while group 1 patients had significantly higher likelihood of PB after THC placement (59.7 times higher). The authors also observed lower rate of systolic blood pressure (SBP) in group 2 patients after five minutes of injections. Epinephrine-containing lidocaine was generally well tolerated and caused no significant cardiovascular disturbance.
The use of epinephrine-containing lidocaine (instead of plain local anesthetics) during THC insertion may reduce superficial PB and improve patient comfort, conclude the authors.
Link to the study: https://onlinelibrary.wiley.com/doi/abs/10.1111/hdi.12686