Tesio Catheter Research Articles

P0631COMPLICATIONS OF TREATMENT WITH HIGH CUT OFF FILTERS FOR ACUTE KIDNEY INJURY SECONDARY TO MULTIPLE MYELOMA

Abstract Background and Aims Acute kidney injury is a frequent complication of MM that can affect 18 to 56% of patients and more than 10% end up needing dialysis. One of the drawbacks associated with the technique is attributed to the albumin loss. The other complications are related with the dialysis technique itself, especially infections, as highlighted by the Eulite study. The objective of the study is to check that there are no more complications in dialysis with High Cut Off filters than in conventional Hemodialysis. Method We are the referral hospital in our community in the treatment of acute kidney injury secondary to myeloma. We have performed 28 treatments of hemodialysis with High cut off filters (HD-HCO). The HD-HCO protocol includes daily dialysis session of 6 hours during the first 6 days to subsequently switch to dialysis every other dayuntil free light chains levels below 500 mg/L, or until the recovery of renal function allows the independence of dialysis. All these patients have a chemotherapy regimen based on Bortezomib (25 of the 28 treatments) and Dexamethasone (28 treatments). A retrospective analysis of the 28 treatments that are performed with HD-HCO after 8 years of experience (July 2011 to May 2019) to demostrate the presence of the same complications as the conventional Hemodialysis. Results Loss of albumin is one of the main drawbacks of the technique. Our patients had no changes in albumin levels due to the fact that our protocol includes the infusion of 2 vials of 20% albumin of 50 ml. at the end of each HD-HCO session. Figure 2 Another concern is intradialytic complications. We have reviewed this topic and our results show that patients in HD-HCO do not present a greater number of complications than those who dialyze with HD-HD or other conventional dialysis. The total number of sessions was 298. 21 patients developed hypotension (7%). The number of sessions in which the patient presented fever was 6 (2%), coagulation of the circuit occurred in 23 sessions (7,7%). The catheter dysfunction (when it does not allow to reach 250 ml/min of blood flow) in 26 times(8.7%) and only 13 times the replacement of the catheter (4.26%) was necessary, consequently, in those who required a greater number of dialysis sessions. In only 1 case (patient who required 27 sessions) to place a permanent Tesio catheter was necessary. Figure 1 In referring to complications of dialysis for AKI secondary to myeloma, few studies consider them. These studies focus on quantifying the reduction of light chains and the efficiency of the treatment, but don’t keep in mind the record of the complications. In the EuLITE study, authors observed a greater number of lung infections in the HD-HCO group (12 vs 3) p = 0.014 and attributed this difference to extended dialysis and albumin loss.We have not observed this problem. The levels of albumin are stable with our infusion protocol of 2 vials of 20% human albumin of 50 ml at the end of each HD-HCO. There’s no more complications than conventional dialysis, even infection ones. 13 febrile episodes occurred in 6 patients (more than 37,5ºC). Blood cultures were collected in all patients, being positive in only 4 patients. Germs found were: Escherichia coli (treated with Amoxicilin/clavulanic), Staphylococcus aureus (treated with Daptomycin), Staphylococcus epidermidis (treated with Meropenem) and Klebsiella pneumoniae (treated with Meropenem too). This 4 patients were the ones who required the replacement of the catheter. Conclusion 1. - Our findings indicate that the HD-HCO has the same safety profile as the conventional Hemodialysis. 2.- There is no serious infectious complications in our patients despite of the fact that all of them are immunosuppressed patients (AKI secondary to Multiple Myeloma in patients treated with chemotherapy)

A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion

ObjectiveThe purpose of the study was to aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF. MethodsOver a period of 12 months, 14 patients with acute thrombosis of their AVFs underwent 18 procedures in a single center for AVF salvage. All 14 patients presented with chronic renal failure, and six were diabetic. All patients were treated under duplex guidance alone. Treatment included simple balloon dilation and maceration (group A; n =10 procedures [56%]) for subacute thrombosis or pharmacomechanical thrombectomy (group B; n = 8 procedures [44%]) for more hypoechoic thrombus. A successful procedure was defined as immediate restoration of flow through the AVF. ResultsOf the 18 procedures, 13 (72%) were successful. Of the 14 patients, thrombus was located at the perianastomotic AVF in 6 (43%), proximal-mid AVF in 6 (43%), mid AVF in 1 (7%), and distal AVF in 1 (7%). From group A, six (60%) were successful. From group B, seven (88%) were successful. Among the unsuccessful procedures, one group B patient was hypercoagulable (polycythemia vera). Of the 18 procedures, 16 (89%) were treated within 2 weeks from when duplex revealed the presence of thrombus. Early rethrombosis (<1-month patency) occurred in three cases (17%), and these patients received new fistulas. Full restoration of the fistula flow was established in 14 cases (78%). Of these 14 patients, 8 (57%) are currently on hemodialysis via fistula, 3 patients (21%) had newly placed fistulas after failed interventions, 2 patients (14%) are not on dialysis yet, and 1 patient (7%) with polycythemia vera disorder is on dialysis via a Tesio catheter (MedComp, Harleysville, Pa). ConclusionsThe sole use of duplex ultrasound imaging to salvage acutely occluded AVFs using percutaneous transluminal angioplasty is a safe and effective alternative to traditional treatment of thrombosed failing/maturing AVF.

Anaphylaxis after disinfection with 2% chlorhexidine wand applicator

A 54-year-old man with end-stage renal failure attended for dialysis. Within seconds of applying 2% w/v chlorhexidine (ChloraPrep 3 mL Wand Applicator) to the skin surrounding the insertion point of...

Comparison of Tesio and LifeCath Twin Permanent Hemodialysis Catheters: The VyTes Randomized Trial

Central venous catheters for maintenance hemodialysis (HD) are designed to attain the required dialysis dose through sustained high blood flow rates (BFR). The authors studied the immediate and long-term performance and complications of two twin-catheter systems, the Tesio catheter (TC) and the LifeCath Twin (LC), to inform clinical practice. This single-center randomized controlled parallel-group trial allocated 80 incident patients (1:1) to receive either a TC (MedComp) or LC (Vygon). Patients were dialyzed to target BFR 450 mL/min and followed up for 12 months. The primary outcome was achievement of target BFR during the first HD session. Secondary outcomes included thrombotic dysfunction, displacement and catheter-related infection. Catheter dysfunction was defined by a BFR ≤ 250 mL/min. More LCs reached the primary endpoint (44% vs. 10%, p=0.001) delivering a higher BFR (mean 383±82 vs. 277±79 mL/min, p<0.001). Significant differences in BFR persisted until the fourth dialysis session. Rates of catheter-related bacteremia (0.40 vs. 0.51/1,000 catheter days, p=0.7) and exit site infection were similar between groups (0.24 vs. 0.09/1,000 catheter days, p=0.4). Overall rates of catheter dysfunction were 2.8/1,000 catheter days (95% CI 2.1-3.5), with no differences in thrombolytic lock use although the LC group required more thrombolytic infusions (6 vs. 0, p=0.01). The LC can deliver greater BFRs in the first three HD sessions following insertion although this did not translate into differences in performance, dialysis adequacy or complication rates with long-term use. Both catheter types can consistently deliver high BFRs over an extended period of time.

Successful Retrieval of an Irretrievable Jugular Tesio Catheter Using a Fogarty Arterial Embolectomy Catheter

Long life expectancy and wide development of therapies have increased the number of patients under artificial treatment for lost kidney function or dialysis. Different options for vascular access are suitable for receiving this therapy. The use of tunneled catheters has consequently increased complications related to its use. A difficult retrieval of catheters caused by a hard fibrin sheath along its trajectory is a common drawback. Herein, we report a woman with suspicion of hemodialysis catheter infection and an irretrievable Tesio catheter. A novel technique using a Fogarty arterial catheter allowed a successful retrieval and avoided an aggressive management.

A Refinement of Hong's Technique for the Removal of Stuck Dialysis Catheters: An Easy Solution to a Complex Problem

A long-term tunneled hemodialysis catheter can be difficult or impossible to pull out if a fibrin sleeve has attached it to the venous wall. We report the outcome of a refinement of Hong's technique for removing incarcerated catheters aimed at improving its feasibility and safety. We applied a modification of Hong's technique in four patients (two males, age ranging from 51 to 68 years) with jugular twin hemodialysis catheters (five of eight lines incarcerated). Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from adhesions. In our technical refinement, we cut the catheter close to its venous entry point in order to facilitate pullout and inserted a valved introducer as access for guide wires as well as for inflations of the catheter balloon. A stiff guide wire was placed in the inferior vena cava to avoid potential damage to heart cavities. Dilation was monitored under fluoroscopy with constrictions showing points where the catheter was incarcerated. If adhesions persisted through the same introducer, endoluminal dilations were repeated with a larger diameter balloon until the catheter was released. New catheters can be positioned using the stiff guide wire already in place. All removals were carried out under local anesthesia in an angiographic room by interventional radiologists. All catheters were successfully removed without complications. Average fluoroscopy time for removal was 12 minutes. In the case of a Tesio catheter removed after 12 years because of infection, a computed tomography scan 2 months later revealed persistence of a calcified fibrin sleeve in the vessel. Hong's technique was confirmed to be a simple, safe and highly effective way to remove incarcerated long-term central venous catheters. The refinements we adopted made the procedure more flexible and possibly less prone to complications. By properly using ordinary tools available anywhere, Hong's technique could be considered Columbus' egg in this previously risky field.

Vascular access for chronic hemodialysis in a patient with epidermolysis bullosa dystrophica Hallopeau‐Siemens

Epidermolysis bullosa is a rare genetic hereditary disease characterized with mechanobullous dermatosis. Except cutaneous, these patients have various extracutaneous manifestations and some types of epidermolysis bullosa comprise almost all organ systems. Because of prolonged life span, chronic renal insufficiency has become an important cause of morbidity and death in these patients. Establishment of functional vascular dialysis access is a great challenge for both the doctors and the patients. Multidisciplinary approach is essential. We present a case of successful establishment of dialysis access via Tesio catheter in a young woman suffering from epidermolysis bullosa dystrophica Hallopeau-Siemens and end-stage renal disease. Since then, the Tesio catheter inserted via the right internal jugular vein has been the functional mean of dialysis. The patient was given the opportunity to lead a quality and active life in spite of disabling disease. Several cases of successful dialysis access establishment with dialysis catheters via central veins have been reported. We report the successful establishment of long-term dialysis access via Tesio catheter and suggest this approach as ideal for these patients. This is the first report dealing with vascular access in this group of patients.

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.

Experience of 70-cm-long femoral tunnelled twin Tesio catheters for chronic haemodialysis

Tunnelled femoral catheters with their tip in the lower inferior vena cava (IVC) are proposed only in few cases, but they often provide less than optimal blood flows and frequently have complications. The aim of this prospective observational study is to evaluate the use of 70-cm-long tunnelled cuffed femoral twin Tesio catheters with their tip in the upper IVC for haemodialysis. Between May 2007 and May 2009, 25 tunnelled femoral catheters (fCVC) have been placed in 25 patients (77.7 +/- 10.8 years) with exhausted thoracic venous accesses or old patients with several comorbidities. Two 10 Fr carbothane 70-cm-long Tesio catheters with a Dacron cuff at 45 cm from the tip were placed in the femoral vein of each patient and then tunnelled; tips were in the upper third of the IVC. fCVCs were removed for either malfunction (Qb < 200 ml/min) or infection that did not resolve with antibiotics. Technical success of placement was 100%. The 6- and 12-month assisted primary patency rate were respectively 67 +/- 13% and 54 +/- 17%. The mean session Kt/V was 1.45 +/- 0.19, and the blood flow was 270 +/- 17 ml/min. Six fCVCs have been removed: three for infection, one for accidental damaging and two for the making of a different vascular access. The main complications were 2 catheter tip thrombi, 3 tunnel infections and 11 fCVC-related bacteraemia (1.77 episodes per 1000 CVC-days). The placement of twin fCVCs with their tip in the high IVC can provide an adequate dialysis and can be considered for patients with no remaining thoracic accesses.

Mechanical Complications of Long-Term Tesio Catheters

Vascular access catheters such as Tesio-Caths are preferentially inserted in the internal jugular vein and serve as access for hemodialysis. Complications related to the removal of these types of lines are uncommon. We report four patients in whom the tip of the Tesio-Cath broke and was left stuck in the superior vena cava. Although there is no defined limit to the maximum length of stay of vascular access catheters for dialysis, the possibility of catheter entrapment should be considered. It remains to be determined whether removing Tesio-Caths every 16- 18 months is beneficial in avoiding this complication.

Vena cava superior syndrome: surgical treatment of the thrombosis of the superior vena cava after implantation of a hemodialysis catheter – a case report and review of the literature

One of the rare reasons of the non malignant superior vena cava syndrome is the thrombosis of superior vena cava. Obstruction or occlusion of central veins is one of the many complications of the more and more frequently used central venous catheters and pacemaker electrodes. The authors report a case of superior vena cava thrombosis resulting in dialysis catheter insufficiency in case of a young, uraemic, female patient wit Tesio catheter and the surgical treatment of it with the use of cardiopulmonary bypass during the operation. Apropos of this case, the authors outline the causes of malignant, non-malignant and iatrogenic superior vena cava syndrome, furthermore the conservative, surgical and catheter therapy of the syndrome.

Tesio Catheter Access for Long-term Maintenance Hemodialysis

To retrospectively determine the long-term outcome (>6 months) of placement of tunneled hemodialysis catheters. The HIPAA-compliant study protocol was approved by the Committee on Human Research, which waived the requirement for informed consent. The records of patients who underwent hemodialysis with the Tesio system (Medcomp, Harleysville, Pa) at a single outpatient dialysis unit between March 1994 and March 2004 were reviewed. The length of catheter access and the requirements for percutaneous revision were recorded, and unassisted- and assisted-access survival times were computed by using the Kaplan-Meier method. Three hundred three primary Tesio accesses were created in 200 patients (mean age, 62.3 years +/- 16.3 [standard deviation]; 102 women [51.0%]). Fifty-nine of 303 accesses (19.5%) were percutaneously revised with catheter exchange. During follow-up, 200 of 303 accesses (66.0%) were terminated (117 because they were no longer needed and 83 because of catheter malfunction), and 103 (34.0%) accesses were functioning at the time of last follow-up. The mean duration of catheter access was 247 days (range, 3-2016 days). One hundred twenty-six (41.6%) accesses remained in use for more than 6 months; 50 (16.5%), for more than 1 year; 20 (6.6%), for more than 2 years; 14 (4.6%), for more than 3 years; and five (1.7%), for more than 4 years. Assisted-access survival was 78.1%, 60.0%, 51.5%, 51.5%, and 46.8% at 6 months and 1, 2, 3, and 4 years, respectively. Tesio catheters frequently function for periods longer than 6 months and, when necessary, they can function for many years.

Unusual Long-Term Complication of Permanent Central venous Catheter for Hemodialysis. Review of the Literature on Mechanical Complications

The ideal dialysis access ensures adequate blood flow for dialysis, has a long life, and is associated with a low complication rate. Although no current type of access fulfills all these criteria, the native arteriovenous fistula (AVF) is close to doing so. Unfortunately, various kinds of vascular access (VA) are becoming more and more necessary to enable hemodialysis (HD). The central venous catheter (CVC), which is associated with higher morbidity and mortality, could be the only viable option to maintain permanent VA. We report an unusual complication in a patient, a 74-year-old female, who had been undergoing HD via a CVC for 14 yrs. A polyurethane CVC with a double lumen was inserted into the right internal jugular vein because an AVF was not feasible, and a polytetrafluoroethylene (PTFE) prosthesis was obstructed. In 2003, the CVC was removed due to stenosis and occlusion of the superior vena cava. A new CVC, also made of polyurethane and with a double lumen, was inserted into the left femoral vein. In January 2005, the patient reported a small rupture of about 3–4 mm located under the cuff of the CVC. For this reason, the left femoral vein had to be used, replacing the Optiflow one with a 40-cm long Tesio CVC, and the second catheter was inserted into the right femoral artery by conventional surgery. After 10 months, the patient returned once more, after the CVC in the left femoral vein had been removed because of malfunction and that the attempts to cannulate the same vein again had failed. Currently, two 70-cm long Tesio catheters implanted in the right femoral vein (whose tips almost reach the diaphragm) are used for dialysis sessions. The number of CVC implants has progressively increased amongst HD patients who are elderly, diabetic or who have been on long-term HD. The patient described in this case report is currently using a 70-cm long double Tesio catheter (single Tesio CVC in SPI silicon) placed in the right femoral vein. She has resumed therapy with dicumarol anticoagulants, maintaining INR within the 2.5–3.5 range. In conclusion, both the increase in the use of venous catheters for HD and in the survival of dialysis patients contribute towards the observation of rare complications associated with CVC use.

Transhepatic venous access as an alternative for Tesio catheter in the case of a patient on haemodialysis with antiphospholipid syndrome

Transhepatic venous access as an alternative for Tesio catheter in the case of a patient on haemodialysis with antiphospholipid syndrome

Neonatal Hemodialysis and Continuous Renal Replacement Therapy

After completing this article, readers should be able to: 1. Describe catheters, dialyzers, and blood lines in hemodialysis for neonates. 2. Explain the blood prime and hemodialysis prescription in hemodialysis for neonates. 3. List potential complications of hemodialysis for neonates. 4. Identify the types of continuous renal replacement therapy (CRRT) in neonates. 5. Explain the dialysis prescription and anticoagulation options for CRRT in neonates. 6. List potential complications of CRRT in neonates. Since the mid-1980s, when dialysis manufacturers began making dialyzers and blood circuit paths that required smaller extracorporeal volumes, hemodialysis has been used successfully to manage renal failure in neonates and infants. Compared with peritoneal dialysis (PD), which is analogous to the “family sedan” in the world of dialysis (slower, more predictable, easier to operate), hemodialysis is the “race car.” Hemodialysis is capable of removing fluids and solutes much more rapidly than is PD. Unlike PD, hemodialysis uses catheters that access the intravascular space directly. Despite the advantages of hemodialysis, the process in neonates is technically more challenging than PD due to the very attributes that make it so effective. Rapid removal of intravascular fluids, exceeding the rate of refill from the extravascular space, causes problems with hypotension due to direct reduction in intravascular volume. Similarly, rapid rates of solute clearance can cause problems with increased intracranial pressure. Catheter placement and maintenance of catheter function can constitute a significant obstacle to hemodialysis. Hemofiltration is very similar to hemodialysis in that patient blood is circulated through an artificial kidney. However, hemofiltration differs from hemodialysis in three significant aspects. First, the hemofilter has larger pore sizes than the standard dialyzer, which allows for excellent fluid removal, even with low blood flow rates, and better larger molecule clearance. Second, hemofiltration runs continuously without the continuous presence of a dialysis nurse. Third, typical hemofiltration uses a pre- or postdilution …

Preliminary experience with a new design for a tunneled, cuffed catheter for hemodialysis

Purpose: The use of tunneled, cuffed central venous catheters for hemodialysis is associated with poor flow, thrombosis, and infections due to the transcutaneous nature of these devices. A new design for a sutureless, tunneled cuffed catheter was evaluated in hemodialysis patients to determine the effect of its design on the incidence of exit site infection. Methods: A polyurethane conduit with a uniquely designed cuff and subcutaneous skirt covered with Dacron velour was attached to standard double lumen central venous catheters. Seven (7) Ash catheters and one (1) Tesio catheter were fitted with the overtube and skirt and implanted in eight (8) patients undergoing routine hemodialysis. Patients were monitored for exit site infection, tunnel infection, bacteremia, cuff extrusion, and serosanguineous exudate. Results: Catheters were implanted for 6 to 26 weeks. All catheters remained patent and no cases of bacteremia were observed. There was no evidence of exit site or tunnel infection, and no reported serosanguineous exudate from the exit site. Exit site care consisted of soap and water cleansing by the patient. Patients were able to shower or bathe 4 weeks post‐implant. Conclusions: The new design for a subcutaneous cuff and skirt appears to inhibit exit site infection and other common complications of central venous catheters.

Salvage Insertion of Tunneled Central Venous Catheters in the Internal Jugular Vein after Accidental Catheter Removal

Tunneled catheters are widely used for intermediate to long-term hemodialysis (HD) access, but are prone to several complications that can require catheter replacement. Replacing malfunctioning catheters with a new line, placed in a different access site, can lead to problems with multiple vein occlusions. This has led many nephrologists to continue using the same vein as long as possible by guidewire catheter exchanges, to preserve other veins for future use. We describe a guidewire exchange technique for the Ash-Split catheter in the internal jugular vein. In three patients, the exchange was performed because of partial catheter removal, as evidenced by the outward dislocation of the Dacron cuff. In these patients, the guidewire was inserted through the catheter. In two additional patients, the catheter had been completely removed by accident: the replacement of the dislodged tunneled venous catheters was attempted 5 hr and 1 day after accidental removal. In these patients, the guidewire was inserted through the previous tunnel. After guidewire placement, a skin incision was made in the supraclavicular region. The metal guidewire was easily located inside the fibrous structure that had previously surrounded the catheter. The guidewire was then extracted from the subcutaneous tunnel and used to insert a new catheter safely and easily after creating a new tunnel. Patients were routinely given antibiotic prophylaxis (1 g of cefazolin) immediately before the procedure. A strict aseptic technique was used, including several sterile glove changes. No infections developed following this procedure, which has the potential for bacterial contamination. All procedures were successful. Only in one patient did we have to convert to a different catheter: it was not possible to replace the old Ash-Split catheter with the same dual-lumen catheter because of difficulties in inserting the peel away introducer-catheter complex. In this patient, rather than forcing it with larger dilators or trying to disrupt the fibrin sheath with balloon dilatation, a single lumen Tesio catheter was successfully placed. In both patients who completely lost the previous catheter, the guidewire was readily reinserted through the subcutaneous tunnel into the vein. Catheter function was excellent in all patients, with a test blood flow rate on the 1st catheter use >350 ml/min. We described a new method for catheter exchange, which allows the easy insertion of a new catheter and the creation of a new and safer subcutaneous tunnel. In addition, we demonstrated that in cases of complete catheter removal, it is possible to reinsert a catheter in the same vein through a guidewire, even when reinsertion was attempted up to 1 day later.

Central Venous Catheter Access in Children on HD

Central venous catheters (CVC) remain a frequently used form of vascular access in children receiving chronic hemodialysis (HD). Whereas standard dual‐lumen catheters (DL) are used in many centers, the Tesio catheter has proven to be superior to the DL catheter in terms of catheter survival and infection rates in at least one pediatric study (Sheth RD et al. Am J Kidney Dis. 2001). Recently, the Ash Split catheter became available which, while similar to the Tesio internally, being comprised of 2 separate catheters, may be preferable because of the requirement for only one skin puncture for placement vs. two for the Tesio. However, no pediatric data pertaining to the Ash Split catheter have been published to date. Therefore, we reviewed and compared our experience with a small number of Ash Split (# 16) and Tesio (# 8) catheters used for semipermanent vascular access in our chronic HD population with reference to survival, infectious complications, patency, and dialysis adequacy. The results of this experience are as follows: Tesio Ash Split Survival &gt;3 months 6/8 12/15 Sepsis (epi/catheter mo) 1/30 1/25 Exit‐site infection (epi/catheter mo) 1/8.6 1/19 sp Kt/V urea 1.67 1.88 % sp Kt/V urea &gt;1.2 100 90 Reasons for the removal of Tesio catheters were transplant (4), sepsis (1), deterioration of tubing (1), and accidental (1). Ash Split catheter removal resulted from sepsis (2), fistula placement (4), thrombosis (1), and accidental (2). This preliminary experience reveals similar outcome data for the Tesio and Ash Split catheters when used in pediatric HD patients. Definitive statements regarding the superiority of either catheter awaits additional data collection and analysis.

The Safe Medical Device act and its impact on clinical practice.

Hospital patients often require vascular access devices to deliver infusion therapies. These can include peripheral intravenous catheters (PIVs), peripherally inserted central venous catheters (PICCs), triple lumens, ports, and Tesio, Swann-Ganz, and Hickman catheters. Although these products are used in large numbers without significant sequelae, when a device fails, the impact is realized throughout the industry. The infusion clinicians within our institution followed a systematic approach to dealing with the failure of devices that occurred over a 3-month period. This article describes the response process when a device fails and the methods of achieving positive patient outcomes.

Roman Tunnelling Tool

Abstract: The aim of this paper is to present an instrument that helps to create a subcutaneous path for central catheters used for hemodialysis, as well as a non traumatic internal introduction of Tesio's catheters and other systems (Dacron cap). We have designed a tunneling tool which consists of a solid but light weight hand set, connected to an extension that ends with an olive shape dilator to be connected to a trocar. Thus, precise tunneling is guaranteed through a non traumatic procedure, allowing exact anchorage of catheters.