Hemodialysis Catheter Placement Research Articles

Long-Term Outcomes after Percutaneous Transluminal Angioplasty for Hemodialysis Catheter Placement

Long-Term Outcomes after Percutaneous Transluminal Angioplasty for Hemodialysis Catheter Placement

Risk Factors associated with Central Vein Stenosis Development in Hemodialysis Vascular Access among Patients with Normal Preoperative Venography

We aimed to discover risk factors for central vein stenosis (CVS) in hemodialysis patients with normal preoperative venography. Among the 411 individuals who underwent upper arm venography for hemodialysis access evaluation in 2017, we reviewed venography and medical record data from 349 patients with normal preoperative venography who subsequently underwent arteriovenous fistula creation. We compared the data between patients with and without CVS development. Among the 349 patients, 22 (6.3%) developed CVS during a median 20.9-month follow-up. The development of CVS appeared to be associated with preoperative venography findings (the presence of collateral vessels and cephalic arch stenosis), location of hemodialysis access, and history and duration of ipsilateral hemodialysis catheter placement (p < 0.05). Multivariate analysis identified two or more collateral vessels on venography, left-sided arteriovenous fistula, and a previous history of ipsilateral hemodialysis catheter placement as independent risk factors for CVS development (p < 0.05). Even in patients with normal preoperative venography findings, there is an increased possibility of CVS development after arteriovenous fistula creation if they have more than two collateral vessels on venography, a left-sided arteriovenous fistula, or a history of ipsilateral hemodialysis catheter placement.

Placement of tunneled hemodialysis catheters - interventional standard.

While the native arterio-venous fistula (AVF) remains the first choice in vascular access for most hemodialysis patients, tunneled hemodialysis catheters (tHDC) continue to be an option in selected patients. Since timely access to vascular surgery-due to delayed referral or resource limitations-is not always possible, nephrologists have to become more actively involved in planning, creation and monitoring of vascular access. Moreover, this approach could also strengthen patient-centered care in nephrology. This manuscript reviews the current standard in tHDC creation, patient selection and strategies to mitigate the risk of infectious complications and catheter thrombosis. Presentation of novel developments in catheter placement with ultrasound-guided or ECG-guided positioning, their benefits and possible disadvantages emphasizes the complexity of vascular access planning. We offer an approach for choice of insertion method, depending on selected side and existing resources and set focus on the necessity and required resources of 'interventional nephrology' training programs.

Percutaneous Retrieval of a Peeled-off Fragment of a Hydrophilic Wire after a Cuffed Tunneled Hemodialysis Catheter Placement: A Case Report.

Percutaneous Retrieval of a Peeled-off Fragment of a Hydrophilic Wire after a Cuffed Tunneled Hemodialysis Catheter Placement: A Case Report.

Outpatient hospitalist-run procedure service bridges the gap in oncology care

Hospitalist-run procedure teams enable expedited care in the inpatient setting. However, wait times for outpatient interventional radiology (IR) are long at our institution. Our study thus aims to compare the safety and wait times between procedural teams and IR placement of outpatient temporary hemodialysis catheters (THDC) for patients undergoing Chimeric antigen receptor T-cell (CAR-T) therapy apheresis. A retrospective chart review was conducted on all patients receiving outpatient THDC for CAR-T therapy from August 2019 until November 2022. During our study period, only 7 of the central lines were placed by IR, while 75 were placed by the procedure service. The average wait time from CAR-T consenting to procedure was 8.9 days for the procedure service and 14.7 days for IR. The 30 day minor complication rate was low – 2.7% in the procedure group, and 0% in the IR group. No major complications were noted in either group

Correlation between Duration of Placement of Non-tunneled Hemodialysis Catheter and Positive Bacterial Culture Incidence in Hemodialysis Patients

Non-tunneling hemodialysis catheter is one of the most convenient vascular accesses for hemodialysis in End Stage Kidney Disease (ESRD) patients. However, these catheters have the highest morbidity among all available accesses. Current guidelines recommend that non-tunneled hemodialysis catheters be placed for no more than 2 weeks to prevent bacterial contamination. This study was conducted in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, throughout January-December 2021. A correlation test with a prospective observational analysis design was applied to find the link between the duration of non-tunneled hemodialysis catheter placement and the incidence of positive bacterial culture on the catheter. Pearson correlation test was used to see the strength of the correlation, with a significance limit of 0.05. This study involved 28 subjects. The most common location for catheter placement was in the jugular vein, and laboratory examinations showed no correlation between leukocyte values and positive bacterial culture results. Hypertension and diabetes mellitus were not significant risk factors (p-value 0.887). At ≤14 days of catheter placement, only 1 (6.7%) of the subjects presented a positive culture result. Most of the positive bacterial culture results were found at a duration of 15-30 days of placement, (n=8; 53.3%). The results of the Pearson test showed a p-value of 0.036 and an r-value of 0.399, indicating a significant result with a strong correlation between the two variables. The duration of placement of hemodialysis catheters has a positive correlation with the incidence of positive bacterial cultures, which can increase the risk of systemic infection associated with hemodialysis catheters.

Alternative dialysis access strategies: A case report of a patient with transrenal hemodialysis catheter due to exhausted traditional routes and review of literature.

Vascular access is the primary lifeline for patients with end-stage renal disease. While arteriovenous fistulas and grafts are the conventionally favored methods for dialysis therapy, certain patients may deplete these traditional vascular access options due to various reasons. In the quest for alternatives, unconventional vascular pathways could be considered, including transhepatic, trans-lumbar and trans-renal approaches. We present a case of a 61-year-old male who exhausted all the traditional vascular access options, therefore trans-renal hemodialysis catheter placement was performed. Overall, this case highlights the challenges of securing a reliable vascular access to perform dialysis therapy and implementing unconventional methods whenever regular means are exhausted.

The wandering ghost: A rare case report dealing with an incarcerated hemodialysis femoral venous catheter and its successful retrieval

Abstract The increasing prevalence of chronic kidney diseases worldwide has eventually increased the demand for dialysis. It is usually achieved by creating an arteriovenous fistula or by the placement of temporary hemodialysis catheters. Without a doubt, the creation of an arteriovenous fistula is the best long-term solution for patients needing frequent dialysis because it carries the least risk of infection. We report a rare case dealing with a fractured and incarcerated single-lumen nontunnel temporary hemodialysis catheter secured in the right femoral vein, and the procedure opted for its successful retrieval from the right external iliac vein.

S3081 A Case of Downhill Esophageal Varices Secondary to Prior Hemodialysis Catheter Placement

S3081 A Case of Downhill Esophageal Varices Secondary to Prior Hemodialysis Catheter Placement

Risk factors for infection in patients with a failed kidney allograft on immunosuppressive medications.

Patients with a failing kidney allograft are often continued on immunosuppression (IS) to preserve residual kidney function and prevent allosensitization. It has been previously accepted that maintaining patients on immunosuppressive therapy results in an increased risk of infection, hospitalization, and mortality. However, as the management of IS in patients with a failed kidney allograft continues to evolve, it is important to review the data regarding associations between infection and specific immunosuppression regimens. We present a review of the literature of failed kidney allograft management and infection risk, and discuss practices for infection prevention. Fifteen studies, published from 1995 to 2022, which investigated the experience of patients with failed allograft and infection, were identified. Infection was most commonly documented as a general event, but when specified, included infections caused by Candida, Mycobacterium tuberculosis, and Aspergillus. In addition, the definition of reduced "IS" varied from decreased doses of a triple drug regimen to monotherapy, whereas others did not specify which medications patients were receiving. Despite attempts at lowering net immunosuppression, patients with failed allografts remain at risk of acquiring opportunistic and non-opportunistic infections. Although opportunistic infections secondary to IS are expected, somewhat surprisingly, it appears that the greatest risk of infection may be related to complications of dialysis. Therefore, mitigating strategies, such as planning for an arteriovenous (AV) fistula over a hemodialysis catheter placement, may reduce infection risk. Additional studies are needed to provide more information regarding the types and timing of infection in the setting of a failed kidney allograft. In addition, more data are needed regarding specific medications, doses, and timing of taper of IS to guide future patient management and inform strategies for infection surveillance and prophylaxis.

Feasibility Analysis of Ultrasound-Guided Placement of Tunneled Hemodialysis Catheters

Radiographic fluoroscopy is the current standard for placement of tunneled central venous catheters (CVCs) for hemodialysis. Radiographic fluoroscopy requires structural and personnel infrastructure and exposes the patient to ionizing radiation. Here, we investigate the feasibility of solely ultrasound-guided placement of tunneled central venous dialysis catheters (USCVCs). We evaluated prospectively collected single-center data regarding safety and catheter function of 134 consecutive patients who underwent USCVC implantation between 2020 and 2021. We used the inset guidewire to visualize the position of the catheter tip. In the case of inadequate visibility by ultrasound, we used intracardiac electrocardiography (ECG) recording or agitated saline. A total of 1844 catheter days were assessed. The optimal CVC position was defined as being within the upper right atrium (URA) and middle to deep right atrium. Of the 134 USCVCs, 87% were placed on the right side. The primary success rate for optimal tip position and catheter function was 98%. Of the USCVCs, 97% were placed solely by ultrasound. Regarding positioning, 6% were in the vena cava superior zone, 70% in the URA and 24% in the middle to deep right atrium, resulting in a rate of 94% with optimal positioning. Effective blood flow averaged 292 ± 39 ml/min. There were no immediate procedure-associated complications. Placement of CVC for hemodialysis solely by ultrasound is an effective alternative to fluoroscopy-assisted placement.

#6898 CATHETER RELATED BLOODSTREAM INFECTION IN NON-TUNNELED HEMODIALYSIS CATHETERS IN A RESOURCE-LIMITED HOSPITAL IN MERIDA, YUCATAN, MEXICO

Abstract Background and Aims There is scarcity in epidemiological data regarding chronic kidney (CKD) disease in low- and medium-income countries, and information about vascular access infectious complications is limited. In Mexico, access to renal replacement therapy (RRT) is burdensome for the uninsured patients. The General Hospital Agustin O'Horán, is a secondary care level unit in Yucatan, which receives uninsured patients from southeast Mexico. In our hospital, patients who are not candidates for peritoneal dialysis start hemodialysis with non-tunneled hemodialysis central venous catheters (NTHC), mainly due to the late nephrology referral and the shortage of vascular access specialists in our unit which prevents for the timely creation of an arteriovenous fistula or the placement of a tunneled hemodialysis catheter (THC). Permanence of NTHC is the main risk factor for catheter related bloodstream infection (CRBI) and according to the literature, Gram positive microorganisms are the most common isolated microbes. The aim of our study was to describe the incidence and risk factors for CRBSI in our hospital, from January to December 2022. Method We conducted a prospective and observational study in patients older than 18 years with CKD who were candidates to start hemodialysis and who had a NTHC inserted in our hospital from January to December 2022. We evaluated the incidence, organisms and risk factors related to CRBSI. Results During the study period, 94 NTHC were placed, 63.8% of them were inserted in women. Median age of the population was 49.4 years, and the most frequent comorbidities were diabetes mellitus (63.8%), hypertension (86.2%) and renal lithiasis (27.7%). 73.4% of the NTHC were Mahurkar® catheters and most of the insertions (73.4%) were not ultrasound guided. The right jugular vein was the most common insertion site (72.3%), followed by the left jugular vein. Mean catheter use duration was 71 ± 66 days. 27 patients had evidence of CRBI, the incidence rate was 0.78 per 1000 catheters-day. CRBI was more frequent in patients with prolonged catheter use (more than 30 days) (p&amp;lt;0.001) (Table 1). In respect to blood cultures reports, 51.83% were Gram positive organisms and 48.12% were Gram negative (Table 2). Conclusion Vascular access survival without infectious complications is of paramount importance in hemodialysis patients. The prolonged used of NTHC with the associated risk for developing CRBI negatively impacts the health outcomes in our population. In accordance to previously published literature, the main isolated microbes in our hospital comprise Gram positive bacteria. One of the biggest challenges in our country is to provide our CKD population with better vascular access options like THC or arteriovenous fistula to improve the outcomes and reduce infectious complications.

Learning Curve for Temporary Hemodialysis Catheter Placement

Training is essential for the safe and uncomplicated placement of hemodialysis catheters. This study explores the learning curve of this procedure. In this prospective study, 60 patients who needed emergency hemodialysis without vascular access were included. All catheters were placed under ultrasound guidance. One nephrologist was included in each two groups, one to be consisted of a junior, and one to be consisted of a senior. Learning curves were created using the cumulative total methodology and receiver operating characteristic curve analyses. The patients' mean age was 67.92 ± 14.23 years. The mean catheter insertion time of the senior nephrologist was significantly shorter than that of the junior. According to cumulative total analysis, the junior group's maximum learning point overlaps with patient 22. When the confidence intervals of the study durations of both groups were examined, they overlapped in the 95% confidence interval starting from the 19th patient. When the mean catheter insertion time of the senior and the mean of the last 12 patients of the junior were compared, there was no significant difference between them (F=15.827, P=.092). The receiver operating characteristic curve analysis showed a cutoff value of 320 seconds for the junior group compared with the senior group, indicating an overlap in case 22 for the junior nephrologist. This study suggests that 22 catheter insertions under the supervision of a senior nephrologist are needed to complete the learning curve for a junior nephrologist. If the number of nephrologists at the center is limited, safe catheter insertion may be allowed after 19 insertions.

Arteriovenous Graft Failure in the Veterans Health Administration: Outcome Disparities Associated with Race.

Background Vascular access for ongoing hemodialysis often fails, frequently requiring repeated procedures to maintain vascular patency. While research has shown racial discrepancies in multiple aspects of renal failure treatment, there is poor understanding of how these factors might relate to vascular access maintenance procedures after arteriovenous graft (AVG) placement. Purpose To evaluate racial disparities associated with premature vascular access failure after percutaneous access maintenance procedures following AVG placement using a retrospective national cohort from the Veterans Health Administration (VHA). Materials and Methods All hemodialysis vascular maintenance procedures performed at VHA hospitals between October 2016 and March 2020 were identified. To ensure the sample represented patients who consistently used the VHA, patients without AVG placement within 5 years of their first maintenance procedure were excluded. Access failure was defined as a repeat access maintenance procedure or as hemodialysis catheter placement occurring 1-30 days after the index procedure. Multivariable logistic regression analyses were performed to calculate prevalence ratios (PRs) measuring the association between hemodialysis maintenance failure and African American race compared with all other races. Models controlled for vascular access history, patient socioeconomic status, and procedure and facility characteristics. Results In total, 1950 access maintenance procedures in 995 patients (mean age, 69 years ± 9 [SD], 1870 men) with an AVG created in one of 61 VHA facilities were identified. Most procedures involved African American patients (1169 of 1950, 60%) and patients residing in the South (1002 of 1950, 51%). Premature access failure occurred in 215 of 1950 (11%) procedures. When compared with all other races, African American race was associated with premature access site failure (PR, 1.4; 95% CI: 1.07, 1.43; P = .02). Among the 1057 procedures in 30 facilities with interventional radiology resident training programs, there was no evidence of racial disparity in the outcome (PR, 1.1; P = .63). Conclusion African American race was associated with higher risk-adjusted rates of premature arteriovenous graft failure after dialysis maintenance. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Forman and Davis in this issue.

Collaboration in nephrology between Geneva and Yaoundé: a convincing example

Chronic kidney disease (CKD) has a high prevalence in Cameroon and will become an important public health problem. Its management must be comprehensive, starting with CKD prevention to the implementation of renal replacement therapies best suited to the needs of patients and resources available in Cameroon. Practical interventions involving nephrology departments in both Africa and Europe can contribute to an improved management of CKD in Africa. The current collaboration between the Geneva University Hospitals and the Yaoundé teaching hospitals is a convincing example. It includes a clinical trial on the treatment of metabolic acidosis linked to CKD, assistance with the placement of hemodialysis catheters by sonography and the initiation of a kidney transplantation program with living donors.

837: CENTRAL VENOUS CATHETER PLACEMENT IN A PRONE POSITIONED PATIENT: POSTERIOR LATERAL APPROACH

Introduction: A significant number of patients with ARDS secondary to Covid-19 pneumonia require prone positioning. Common practice is to return patients to a supine position prior to performing invasive bedside procedures such as central venous access. This may present prohibitive risk in patients with refractory hypoxemia. Description: We present the case of a 46 year old male, admitted to the ICU with Covid-19 pneumonia complicated by ARDS. Intermittent prone positioning was initiated. The patient remained with refractory hypoxemia despite prone positioning, optimal ventilator settings and inhaled epoprostenol. The length of time the patient could be supine progressively decreased. The patient developed AKI necessitating hemodialysis (HD) catheter placement. Attempts to supine patient to perform HD catheter placement resulted in near cardiorespiratory arrest. It was decided to attempt HD catheter placement in the RIJ vein via a posterior lateral approach with the patient prone. Patient was brought to the head of the bed allowing the chin to rest on the edge of the bed with head turned laterally and endotracheal tube supported by the respiratory therapist. The patient was placed in an oblique “swimming position” by aid of a pillow under the center torso and right shoulder girdle. An optimal insertion site was selected via real time ultrasound guidance. Utilizing a micropuncture needle, guidewire, and dilator, a 15cm 12 Fr BARD hemodialysis catheter was placed using a standard Seldinger technique. Discussion: Our experience indicates that a posterior lateral approach for CVC placement is a viable option. Given the complexity of this procedure and the paucity of case reports describing it, we felt it prudent to share our approach. Structures of interest to avoid in posterior approach to the RIJ include the phrenic nerve traveling along the scalenus anterior muscle tissue posterior to the internal jugular vein. Accessing the vein below the omohyoid muscle offers the best opportunity to avoid the phrenic nerve and the scalenus. A steep 90 degree angle to access the RIJ was intentionally attempted to minimize the amount of soft tissue to dilate. Utilizing this approach allowed us to safely and effectively place the line without immediate complications.

Current Trends and Challenges in Nephrology Fellowship Training: Expansion of Education in Home Dialysis, Palliative Care, and Point-of-Care Ultrasound.

Nephrology education has changed significantly since the first nephrology fellowship programs were established in the United States in the 1950s and 1960s. The past several years have seen increased opportunities for subspecialization in areas such as interventional nephrology, onconephrology, and glomerular disease. Notable trends in fellowship curricula include the expansion of education in home dialysis and palliative care, driven by policy changes and focus on patient-centered care. In addition, point-of-care ultrasound has garnered significant interest due to its potential to provide diagnostic information that improves patient care. An important area that remains largely unaddressed appears to be education about the business and administrative aspects of nephrology. Meanwhile, the importance of training in hemodialysis catheter placement and kidney biopsy has come into question due to the small proportion of nephrologists performing these procedures today. Nephrology fellowship programs should strive to tailor their curriculum to meet the interests and needs of individual fellows.

Accidental placement of hemodialysis catheter tip in the right internal mammary vein: a case report

Hemodialysis catheter placement, particularly Internal Jugular Catheter insertion, is a very common procedure for patients who require urgent access to renal replacement therapy. Most of these procedures are done under ultrasound guidance as recommended by KDIGO 2019 vascular access guidelines. However, catheter tip misplacement can still occur even in the experts’ hands and despite the use of ultrasound. In this case report, we will discuss a hemodialysis catheter tip placement in the right internal mammary vein and how we managed it.

Abstract No. 211 Tunneled hemodialysis catheters: does French size and catheter tip type affect patency and post-procedural complications?

Published studies have long shown tunneled hemodialysis catheters have high rates of infection and thrombus related catheter dysfunction. The aim of our study is to examine French size and catheter tip type in relation to primary patency rates, incidence of catheter related infections and incidence of catheter related malfunction in comparison to current literature. To examine these complications, we performed a retrospective chart review of all patients who underwent a tunneled hemodialysis catheter placement at two hospitals at our institution.

High incidence of large bore temporary hemodialysis catheter malfunction in patients with COVID-19 related kidney injury.

To evaluate the incidence of large bore hemodialysis catheter malfunction in the setting of COVID-19. A retrospective review was performed of all patients who underwent placement of a temporary hemodialysis catheter after developing kidney injury after COVID-19 infection at our institution. Data collected included demographic information, procedure related information, and incidence of replacement due to lumen thrombosis. Groups were compared using students t-test for continuous variables and Fisher's exact test for nominal variables. Sixty-four patients (43M, mean age 63.2 ± 13.3) underwent placement of temporary hemodialysis catheter placement for kidney injury related to COVID 19 infection. Thirty-one (48.4%) of catheters were placed via an internal jugular vein (IJV) access and 33 (52.6%) of catheters were placed via a common femoral vein (CFV) access. Overall, 15 (23.4%) catheters required replacement due to catheter dysfunction. There were no differences in demographics in patients who required replacement to those who did not (p > 0.05). Of the replacements, 5/31 (16%) were placed via an IJV access and 10/33 (30.3%) were placed via a CFV access (p = 0.18). The average time to malfunction/replacement was 7.8 ± 4.8 days for catheters placed via an IJ access versus 3.4 ± 3.3 days for catheters placed via a CFV access (p = 0.055). A high incidence of temporary dialysis catheter lumen dysfunction was present in patients with COVID-19 infection. Catheters placed via a femoral vein access had more frequent dysfunction with shorter indwelling time.