Central Venous Catheters For Hemodialysis Research Articles

Catéteres venosos centrales permanentes tunelizados para hemodiálisis: estudio de recirculación y dosis de diálisis con líneas normales e invertidas

Introducción: Los Catéteres Venosos Centrales Permanentes Tunelizados para hemodiálisis presentan con frecuencia una complicación denominada efecto ventana o ventosa, en el que la rama arterial se colapsa en las maniobras de aspiración sin ofrecer resistencia al impeler, determinando la inversión de líneas para poder realizar el tratamiento. El estudio se centra en la relación entre la posición anatómica de las puntas del catéter mediante radiografía de tórax y la recirculación medida con Dilución Ultrasónica, el Porcentaje de Reducción de Urea y el Kt/V, determinados tanto con líneas en posición normal e invertida y a flujos de bomba de 250 y 300 ml/min. Material y método: Estudio Cuasiexperimental Intrasujeto de 18 meses de duración a n=28 catéteres implantados en 25 pacientes en Hemodiálisis. Resultados: • Recirculación: • Líneas normales a 250 y 300 ml/min: 0,85 ± 2,41% y 1,23 ± 3,14%. • Líneas invertidas a 250 y 300 ml/min; 22,41 ± 12,12% y 24,93 ± 12,09%. • Porcentaje de Reducción de Urea: • Líneas normales a 250 y 300 ml/min; 66,49 ± 8,62% y 70,55 ± 5,30%. • Líneas invertidas a 250 y 300 ml/min; 61,05 ± 8,34% y 62,34 ± 8,68%. • Kt/V: • Líneas normales a 250 y 300 ml/min: 1,31 ± 0,30 y 1,46 ± 0,23%. • Líneas invertidas a 250 y 300 ml/min: 1,10 ± 0,21% y 1,19 ± 0,30%. Discusión: Los Porcentajes de Reducción de Urea y Kt/V con líneas invertidas a ambos flujos estudiados, manifiestan dosis de diálisis adecuadas asumiendo recirculaciones entorno al 20%.

Multi-Detector Computed Tomography Venography in the Assessment of Dysfunction of Tunneled Hemodialysis Central Vein Catheters

To assess the value of multi-detector computed tomography venography (MDCTV) in the assessment of tunneled hemodialysis central vein catheters (CVCs) dysfunction. Twenty-five patients who had tunneled CVC dysfunction without abnormality found by x-ray and ultrasound were enrolled. Anti-platelet agents, anticoagulants, and thrombolytic therapy with urokinase failed to resume normal catheter function. MDCTV was performed to observe the position of catheters and to detect central venous stenosis, thrombosis, and fibrin sheath formation. Correct intervention was given according to MDCTV results. MDCTV revealed that the catheter was malpositioned in 10 cases; there were five cases of central venous stenosis, four cases of central venous thrombosis, one case of fibrin sheath formation, and the other five had no abnormalities found. Blood flow on hemodialysis had reached over 300 mL/min after correct intervention. MDCTV provided a new possible way to assess dysfunction of tunneled hemodialysis central venous catheters.

Right atrial thrombus in patients with hemodialysis central venous catheters

Right atrial thrombus in patients with hemodialysis central venous catheters

Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise

OBJETIVO: Avaliar o impacto do uso de Mupirocina tópica em inserção de cateter venoso central para hemodiálise. MÉTODOS: Revisão Sistemática com Metanálise. RESULTADOS: Após uma criteriosa e extensa busca, foram incluídos três ensaios clínicos que compararam o uso de Mupirocina versus outra intervenção em cateter venoso central para hemodiálise. CONCLUSÃO: O estudo apontou que o uso de Mupirocina tópica é eficaz para redução dos episódios de infecções entre os pacientes em hemodiálise, aumentando o tempo de utilização do cateter, além de reduzir significativamente as infecções por S aureus as mais prevalentes nessa população.

Catheter Dysfunction: The Role of Lock Solutions

Vascular access dysfunction is a major cause of morbidity in hemodialysis (HD) patients. An upper extremity autogenous arteriovenous fistula (AVF) that preferentially involves the cephalic vein is the access of choice for HD patients, followed by autogenous AVF utilizing the basilic vein and the use of prosthetic arteriovenous grafts (AVGs). Despite these recommendations, central venous catheter (CVC) use is widespread among both incident and prevalent HD patients. Long-term use of CVCs for HD is complicated by a high rate of infection and thrombus-related dysfunction. Catheter locking solutions have been used both prophylactically and therapeutically for catheter thrombosis as well as catheter-related infections, with varying degrees of success. This review aims to address the different catheter locking solutions, their advantages and disadvantages, and new directions in this field.

Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial

Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock in chronic hemodialysis patients suggest it may be efficacious in preventing infection and thrombotic complications. We compared sodium citrate with saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adult patients. Primary endpoint was catheter life span without complication. This was a randomized, controlled, open-label trial involving intensive care patients with acute renal failure requiring hemodialysis. Events were defined as catheter-related bloodstream infection and catheter malfunction. Seventy-eight patients were included. Median catheter life span without complication was 6days (saline group) versus 12days (citrate group) [hazard ratio (HR) 2.12 (95% CI 1.32-3.4), p=0.0019]. There was a significantly higher rate of catheter malfunction in the saline group compared with in the citrate group (127 catheter events/1,000catheter-days, saline group vs. 26 events/1,000catheter-days, citrate group, p<0.00001). There was no significant difference in incidence of infections between groups. We observed a significantly longer time to occurrence of infection in the citrate group (20days vs. 14days, HR 2.8, 95% CI 1.04-7.6, p=0.04). By multivariate analysis, age and citrate group were the only independent factors that influenced catheter life span. This study shows for the first time that citrate lock reduced catheter complications and increased catheter life span as compared to saline lock in critically ill adults requiring hemodialysis.

Thrombosis of Tunneled‐Cuffed Hemodialysis Catheters: Treatment With High‐Dose Urokinase Lock Therapy

Thrombosis-related malfunction of tunneled-cuffed central venous catheters (TCC) for hemodialysis (HD) currently leads to a high rate of untimely catheter removal. Urokinase (UK) therapy is used for TCC thrombosis/malfunction, but no consensus exists on the adequate dose to obtain thrombolysis. We selected 72 HD patients with TCC and a mean age and HD vintage of 74 years (range 65-87) and 36 months (range 12-61), respectively. All patients received warfarin therapy with a target international normalized ratio (INR) of 1.8-2.5. Coagulative assessment of the patients was obtained by checking the INR, activated partial thromboplastin time, fibrinogen, hemoglobin, and platelets. Sixty-five thrombotic events were recorded during a 3-year follow-up (median 0.3 events/patient/year). The patients selected were randomized into two groups according to a different thrombolytic therapy. Group A comprised 29 thrombotic events in 32 patients who received UK 25,000 IU in both arterial and venous lines of the TCC for each event. UK restored an adequate blood flow rate (BFR) for HD (≥ 250 mL/min) in 4/29 events (13.7%), whereas addition of 50,000 IU to both arterial and venous lines was required in 25/29 events (86.3%). For the same 25 events in the second HD session, a further 75,000 IU of UK was needed for each TCC lumen. Group B comprised 36 thrombotic events in 40 patients who received 100 000 IU of UK in the arterial and venous lumen of the TCC for each event. An adequate BFR was recovered in all events. In 12/36 events (33.3%), 100,000 IU UK for both lumens were needed in the second HD. In conclusion, group B patients obtained (i) a significantly better TCC patency than group A patients; (ii) a low UK administration in the following HD sessions; and (iii) no bleeding complications.

Vascular access type defines survival in patients on dialysis

In contrast to reports of favorable survival in incident patients on peritoneal dialysis compared with hemodialysis, a recent study has shown similar survival outcome depending on type of vascular access. Central venous catheters for hemodialysis have an inherent risk of sepsis, which accounts for the early survival advantage of peritoneal dialysis.

Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

IntroductionCentral venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methodsBetween 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. ResultsUsing the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. ConclusionOur results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

Central venous haemodialysis catheter insertion. Is there any difference to the insertion of central venous catheters for other use?

Background-Aim Central venous catheters (CVC) can be used for mid and long-term venous access allowing administration, monitoring and haemodialysis. The objective of our study is to compare the complications from the insertion of dialysis CVC to those arising from insertion of CVC for other use.

Endoluminal Brushing of Occluded Long Term Parenteral Nutrition Catheters is Associated With a Reduced Need for Catheter Replacemet

Introduction Maintaining venous access is paramount to survival in patients on home parenteral nutrition(HPN),but central venous catheter(CVC) occlusion is a significant reason for CVC removal; this occurs largely due to lipid or fibrin precipitate, so a standard clearance protocol using ethanol, hydrochloric acid (HCl) and urokinase is well established.1 Endoluminal brushing has been used to diagnose CVC sepsis and resolve occluded haemodialysis CVCs.2 We aimed to evaluate the efficacy of endoluminal brushing of occluded HPN CVCs and whether the technique is associated with reduced need for CVC replacement. Methods Data on patient with occluded HPN CVCs (median duration of HPN 29 months) presenting to a National IFU over 7 years were collected prospectively. Endoluminal brushes were withdrawn in March 2006 in the UK due to manufacturing issues so patients were divided into 2 groups: Brushing Group (patients presenting from Dec 2003 to March 2006,all of whom underwent CVC brushing with ‘fibrin analysis system’ (FAS) endoluminal brushes) and Standard Group (patients presenting from April 2006-Sept 2010,who were managed with a standard protocol of urokinase & ethanol flushing; 70% ethanol ± 5000 units urokinase was used in patients predominantly on a lipid regimen; HCl±urokinase was used for glucose/electrolyte regimens). Statistical analysis was performed with chi-squared. Results 68 episodes of line occlusion occurred in 44 patients (48% male; mean age 47) in the Brushing Group; of these,20 patients had undergone failed treatment with the standard occlusion protocol before brushing. Successful clearance was achieved in 36 patients after a median of 1 brushing (range 1–4); line replacement was required in the other 8 patients (18%) after a median of 1.5 brushing attempts(range 1–4).In patients in whom brushing had been successful, 15 patients9 lines reblocked after a median of 10 months(range 1–65). No complication related to brushing was recorded. 69 episodes of line occlusion occurred in 45 patients (52% male; mean age 50) in the Standard Group, with successful clearance achieved in 16 patients; line replacement was required in the other 29 patients (64%; p Conclusion This is the first study to demonstrate that FAS endoluminal brushing is safe and effective in clearing occlusions in HPN CVCs & is associated with a significant reduction in the need for line replacement compared to standard techniques. If endoluminal brushes become available again in the UK, the technique should be evaluated in a prospective controlled study.

Endoluminal brushing of occluded long term parenteral nutrition catheters is associated with a reduced need for catheter replacement

IntroductionMaintaining venous access is paramount to survival in patients on home parenteral nutrition(HPN),but central venous catheter(CVC) occlusion is a significant reason for CVC removal; this occurs largely due to lipid...

Long-term Tesio Catheter Access for Hemodialysis Can Deliver High Dialysis Adequacy with Low Complication Rates

Purpose The use of central venous catheters for long-term hemodialysis has been associated with increased mortality and high prevalence of infection and venous stenosis. However, because central venous catheters still constitute a significant proportion of vascular access in prevalent populations, even in the Fistula-First era, the authors examined the long-term patient outcomes and performance of this vascular access type to inform current clinical practice. Materials and Methods The authors conducted a retrospective cohort study of 433 patients on maintenance hemodialysis in a dialysis program from January 1999 through April 2008 all using twin-catheter Tesio Caths (TCs) (MedCOMP, Harleysville, Pennsylvania). Written and electronic records were examined with respect to laboratory indices as well as mortality, access-related infection, need for thrombolytic infusion, access revision and dialysis adequacy. Results A total of 759 TCs were inserted with 552,035 catheter days follow-up. Thirty-six percent of insertions were in patients incident to dialysis (< 90 days). Mean single-pool Kt/V was 1.6 ± 0.3. Cumulative cohort survival rates were 85%, 72%, and 48% at 1, 2, and 5 years, respectively. No patients died as a result of lack of vascular access. Cumulative assisted primary access site patencies were 76%, 62%, and 42% at 1, 2, and 5 years, respectively. The prevalence of symptomatic central venous stenosis was 5%. Catheter-related bacteremia occurred at a rate of 0.34 per 1,000 catheter days. Conclusions Appropriate use of TCs with protocolized care can deliver effective long-term hemodialysis with good adequacy and rates of access-related infection approaching those seen with arteriovenous grafts.

The effect of heparinized catheter lock solutions on systemic anticoagulation in hemodialysis patients

Hemodialysis catheter thrombosis is associated with loss of catheter patency, catheter-related bacteremia and sepsis. To limit these risks, many renal units use heparin as a catheter-locking solution. In this study we investigate the effect of different concentrations of heparin catheter lock solution on systemic anticoagulation in an investigator-blinded randomized study of patients with non-tunneled (temporary) central venous catheters. 28 consecutive patients requiring insertion of a temporary non-tunneled dual lumen central venous hemodialysis catheter were randomly allocated to receive either heparin 5,000 IU/ml or heparin 1,000 IU/ml as catheter lock solutions. The primary outcome measure was the difference in activated partial thromboplastin time (APTT) at 10 minutes following catheter locking with heparin 5,000 IU/ml and heparin 1,000 IU/ml. Secondary outcomes included intradialytic blood flow rates, catheter removal due to insufficient hemodialysis blood flow to maintain hemodialysis and catheter-related bacteremia. 13 patients were randomized to the heparin 1,000 IU/ml group with 15 patients randomized to the heparin 5,000 IU/ml group. There was a statistically significant increase in APTT at 10 minutes between groups with median +22.2% (range 0 - 210) rise in APTT in the heparin 1,000 IU/ml group compared with +373.7% (range 133 - 800) in the heparin 5,000 IU/ml group (p < 0.001). There was no statistically significant difference between groups with the secondary outcomes of intradialytic blood flow, catheter failure rates and catheter-related bacteremia rates. Heparin 1,000 IU/ml catheter lock solution confers a significantly lower risk of systemic heparinization than heparin 5,000 IU/ml without any overtly detrimental effect on intradialytic blood flow, catheter failure rates and catheter-related bacteremia rates.

Seeing Eye to Eye: The Key to Reducing Catheter Use

Hemodialysis central venous catheters (CVCs) are increasingly used, despite a prevalence target of <10%. The primary aim of our study was to understand why patients persistently use their CVCs. A multicenter prospective observational study surveyed 322 patients and their vascular access coordinators (VACs) to determine the reasons patients use CVCs. Their responses were compared using multirater kappa statistics. An 18-month follow-up survey was applied to a subgroup of patients consistently using their CVCs, and correlated with the VACs' and patients' previous responses. Predictive associations for specific reasons for CVC use were explored. Patients indicated "non-medical" reasons (34.8%), having previously failed fistulas/grafts (25.8%), and fear of disfiguration (11.5%) as the main reasons for CVC use. The VAC was in agreement with the patient 16.5% of the time, in partial agreement 37.0%, and in disagreement 46.5%. Twelve percent of patients indicated a desire to change their CVC, yet the VAC was unaware of this 78% of the time. The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.

Atypical Placement of Hemodialysis Catheters in Patients with Complete and Irreversible Obstruction of Central Venous Vessels

Purpose This article describes the approach to atypical placement of central venous catheters (CVC) in dialysis patients with complete untreatable obstruction of central venous vessels. Methods Five patients with complete obstruction of central venous vessels underwent CT venography and digital venous angiography. After ultrasound-guided and radioscopic-assisted cannulation of the internal jugular vein, permanent CVCs were placed in atypical locations: in two patients a preliminary venous angioplasty was performed to facilitate the catheter positioning in a mediastinal enlarged collateral vein and in a persistent left superior vena cava; in three patients the CVC was placed in the azygos vein, enlarged because of the obstruction of the superior vena cava. Results In all cases, we achieved satisfactory morphological and functional immediate results. Hemodialysis (HD) was carried out long term in all patients except one who presented a non-functioning CVC after 4 months. In one case the catheter, still functioning well after 9 months, was removed due to kidney transplantation. The CVC in the left superior vena cava was replaced with a longer one after 12 months, and it is still functioning well 3 months after replacement. The patency of the other two catheters has to date been kept for 9 and 18 months. Conclusions The placement of CVC for HD in atypical sites can be considered a viable option in extreme cases; adequate imaging support is paramount in order to facilitate the procedure and to avoid complications.

Effectiveness of a Protocol for the Prevention of Hemodialysis Venous Catheter-Related Infections

Infections are a major complication of the use of hemodialysis central venous catheters. In our study we evaluated the efficacy of the hemodialysis central venous catheter protocol management adopted in our center, through a retrospective analysis of all hemodialysis central venous catheters inserted over a period of 6 years. Seventy-three tunneled central venous catheters and 75 temporary central venous catheters were inserted in our center from 2003 to 2008 in 148 patients. During the follow-up we observed 30 infective events (16 assessed as bacteremias, 14 subcutaneous tunnel or exit site infections) with a rate of 0.65/1,000 days of central venous catheter implantation. Our experience confirms, in a 72-month follow-up, the importance of careful central venous catheter management as a crucial feature in reducing the incidence of infective events in patients with central venous catheters in dialytic treatment.

Atypical placement of hemodialysis catheters in patients with complete and irreversible obstruction of central venous vessels

This article describes the approach to atypical placement of central venous catheters (CVC) in dialysis patients with complete untreatable obstruction of central venous vessels. Five patients with complete obstruction of central venous vessels underwent CT venography and digital venous angiography. After ultrasound-guided and radioscopic-assisted cannulation of the internal jugular vein, permanent CVCs were placed in atypical locations: in two patients a preliminary venous angioplasty was performed to facilitate the catheter positioning in a mediastinal enlarged collateral vein and in a persistent left superior vena cava; in three patients the CVC was placed in the azygos vein, enlarged because of the obstruction of the superior vena cava. In all cases, we achieved satisfactory morphological and functional immediate results. Hemodialysis (HD) was carried out long term in all patients except one who presented a non-functioning CVC after 4 months. In one case the catheter, still functioning well after 9 months, was removed due to kidney transplantation. The CVC in the left superior vena cava was replaced with a longer one after 12 months, and it is still functioning well 3 months after replacement. The patency of the other two catheters has to date been kept for 9 and 18 months. The placement of CVC for HD in atypical sites can be considered a viable option in extreme cases; adequate imaging support is paramount in order to facilitate the procedure and to avoid complications.

Hemodialysis catheter: induced giant right atrial thrombus

Transient central venous hemodialysis catheters are used commonly while waiting for arteriovenous fistulas to mature. Thrombosis is a possible complication of indwelling central venous catheters utilized for hemodialysis. However, a giant right atrial thrombus is relatively rare. In this report, we present a case of right atrial thrombus related to transient indwelling hemodialysis catheter, which had been in situ for 45 days.

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.