Tunneled Hemodialysis Catheters Research Articles

Blood Pressure Recordings During Hemodialysis Access Interventions: Implications for Acute Management

A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4-week follow-up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures.

Évaluation des complications infectieuses liées aux cathéters veineux centraux d’hémodialyse en Polynésie française

The arterio-venous fistula (AVF) is the most common vascular access to perform hemodialysis (HD). The HD venous central catheter use should only be proposed to old patients and/or patients without vascular access construction feasibility. These HD catheters are often responsible of infectious and thrombosis complications. We performed, for the first time in French Polynesia, a retrospective study based on 214 patients receiving 618 HD catheters, to evaluate the infectious complication rate due to HD catheters. We showed that 17.4% of HD catheters present with infection. The number of bacteraemia due to HD catheters is 2.57/1000 days-catheters and the number of infection due to HD catheter is 1.43/1000 days-catheters. Eighteen percent of patients requiring an emergency HD without AVF access are transferred in intensive care unit due to infectious HD catheter complications. We observed a similar bacteriological environment than in literature. However, the number of tunneled HD catheter is really lower to that of the number required in European recommendations and we observed an abnormal number of non-functional AVF 1month after creation. These results involve our nephrology unit to increase the number of tunneled catheters to limit the infectious risk and also to fit with the best practices guidelines.

Comparison of results of placement of cuffed –tunneled hemodialysis catheter in internal jugular vein with subclavian vein for long -term dialysis

was to comparison between internal jugular vs. subclavian vein cuffed tunnel catheter placement for dialysis. Cases who required central venous catheter for dialysis were included in this study. Forty cases were included in this study and divided to two groups. Catheters were placed randomly in internal jugular vein or subclavian. Patients were followed for 6 months. Early and late complications of catheter's placement were recorded. Analysis was done using Spss ver 13.0 (Chicago, IL, USA). There were no significant differences between subclavian and internal jugular vein regarding occurrence of infection resulted in extraction or treatment. Also there were no significant differences regarding occurrence of thrombosis resulted in extraction or treatment. Failure rate was significantly higher in cases with internal jugular vein catheter compared to cases with subclavian vein catheter (p=0.04). Failure rate was significantly higher in cases with internal jugular vein catheter compared to subclavian cathether. Subclavian catheter is more appropriate route for catheter placement.

Antibiotic Catheter Locks in the Treatment of Tunneled Hemodialysis Catheter‐Related Blood Stream Infection

We prospectively examined the efficacy of systemic antibiotics and antibiotic catheter locks for the treatment of tunneled hemodialysis catheter related blood stream infections (CRBSI). Patients with clinical signs of tunnel or metastatic infection were excluded. All patients with suspected CRBSI were treated empirically with systemic antibiotics at the onset of symptoms before final culture and susceptibility results were available. Once the organism was identified, antibiotics treatment was tailored and antibiotic catheter locks were instilled after each dialysis treatment. Clearance of infection was documented by negative surveillance cultures after completion of antibiotic course. Out of 46 episodes of CRBSI; 16 were due to gram positive organisms, 22 were due to gram negative organisms, and 8 were polymicrobial (≥2 organisms) infections. 19 cases required removal of dialysis catheter. Antibiotic lock protocol was successful for eradicating infection in 27 of 46 episodes (59%). The likelihood of a clinical cure was identical in both gram-positive and gram-negative infections (63% and 62% respectively). Antibiotic lock protocol remains an option in the treatment of clinically stable patients with CRBSI; however, success rate of this protocol in eradicating the infection is modest.

Endoluminal Dilation Technique to Remove “Stuck” Tunneled Hemodialysis Catheters

Most tunneled catheters can be easily removed after the retention cuff is dissected. Occasionally, these catheters can become resistant to removal even after application of potentially hazardous forceful traction. In addition, an infected catheter may cause life-threatening septicemia. Several methods have been described for their extraction, some of which may be available only in tertiary-care facilities. The present report describes the successful extraction of five such “stuck” catheters by using a recently described technique of endoluminal dilation. The technique appears safe and straightforward and can be performed in any interventional suite while allowing preservation of venous access.

Characteristics of Biofilm on Tunneled Cuffed Hemodialysis Catheters in the Presence and Absence of Clinical Infection

Biofilm occurring on the surface of tunneled hemodialysis (HD) catheters is difficult to eradicate and often is associated with recurrent bacteremia. We studied biofilm formation on catheters from patients with and without bacteremia to identify the location of bacterial growth and measure biofilm thickness. Prospective observational study. 76 adult HD patients; 26 had HD catheters removed for bacteremia and 50 had catheters removed for reasons other than infection. Segment of catheter, reason for catheter removal. Microbiological growth and biofilm thickness on the outer and luminal surfaces of extravascular and intravascular catheter segments. Catheter cultures were positive in 16 (62%) patients with bacteremia and 15 (30%) when the catheter was removed for non-infection-related reasons. In catheters with positive cultures, the outer surface of the extravascular segment was the most common site of bacterial growth (15/16 [94%] and 11/15 [73%] for bacteremic and nonbacteremic patients, respectively). Bacteremic patients had significantly thicker biofilm on all catheter surfaces, and in bacteremic patients, the biofilm was significantly thicker on the outer compared with the luminal surface for both extravascular (14.53 ± 6.17 vs 11.97 ± 5.01 μm; P < 0.001) and intravascular (12.21 ± 5.3 vs 9.46 ± 3.71 μm; P < 0.001) segments. Extravascular segments had significantly thicker biofilm compared with intravascular segments on both the outer (P < 0.001) and luminal (P < 0.001) surfaces. Similarly, in patients for whom the catheter was removed for non-infection-related reasons, the catheter had thicker biofilm on the outer compared with the inner surface in both extravascular (2.19 ± 2.84 vs 1.62 ± 2.33 μm; P < 0.001) and intravascular (1.92 ± 2.62 vs 1.29 ± 2.33 μm; P < 0.001) segments. Similar to catheters from bacteremic patients, the outer and luminal surfaces of the extravascular segments of the catheters had significantly thicker biofilm compared with their corresponding surfaces on the intravascular segments. Observational study. The outer surface of the extravascular segment of tunneled dialysis catheters in both bacteremic and nonbacteremic HD patients has the thickest biofilm and highest microbiological yield, and biofilm is thicker in patients with bacteremia. This knowledge is important for designing preventive strategies and also in the management of patients with catheter infection.

Tunneled Hemodialysis Catheter-Related Bloodstream Infections: A Prospective Multicenter Cohort Study from Spain

Catheter-related bloodstream infections (CRBSI) are common among patients undergoing long-term hemodialysis (HD) worldwide. The aim of this study was look into the incidence, epidemiology, and risk factors for CRBSI in four medical centers and Spanish dialysis facilities following a common protocol for insertion and management of tunneled hemodialysis catheters (THCs). Prospective study including all THCs inserted from September-04 to October-05. Follow-up was from THC insertion to its withdrawal, onset of CRBSI or end of study. Data of all THCs, CRBSI episodes, and catheter complications were collected. A descriptive analysis of CRBSI incidence and etiology and multivariate Cox regression to identify risk factors for CRBSI was performed. A total of 130 THCs in 123 patients were inserted. There were 34 879 catheter-days. Twelve CRBSI in 11 patients with a CRBSI rate of 0.34/1000 catheter-days were recorded. CRBSI was caused by gram-positive coccus in 91.7% of the cases. Vascular cause of renal disease (HR 25.5 CI95% 5.5-117.2), and a previous THC (HR 5.1 CI95% 1.3-19.1) were identified as risk factors for CRBSI. CRBSI were satisfactorily resolved in 83.3% of the cases. Overall mortality was 14.6% (18/123), in two cases (2/11) death occurred within 30 days after CRBSI onset. Although some factors, such as vascular cause of renal disease and previous THC medical history, have been related to the onset of tunneled catheter-related bloodstream infections, the incidence of these bacteremia, mainly produced by gram-positive coccus, is low among hemodialysis patients and the mortality rate is not high.

Effect of Mechanical Brushing on Survival and Hemodynamic Characteristics of Tunneled Hemodialysis Catheters

Tunneled catheters used for hemodialysis treatment often become dysfunctional due to deposition of clotting material within the catheter lumen. In a retrospective study design we investigated the effect of mechanical brushing of dysfunctional tunneled catheters using a metal guide wire with simultaneous installation of urokinase. During a period of 26 months all together 24 different catheters in 21 chronic hemodialysis patients were brushed due to insufficient blood flow or increased arterial or venous line pressures resulting in repeated alarms during dialysis treatments. Median functional survival after brushing was 45 days with 8 catheters being exchanged (n=5) or rebrushed (n=3) within 10 dialysis sessions (4 weeks). After 2 months all together 13 (54%) catheters were exchanged due to repeated dysfunction and by 3 months functional survival was only about 35%. The catheters needing exchange were characterized by low flow and high arterial line resistance already in the dialysis sessions immediately following the brushing procedure. Median survival of the exchanged catheters was considerably longer (>400 days) as compared to the brushed catheters. In conclusion mechanical brushing of dysfunctional tunneled hemodialysis catheters can prolong short term function but only affects long term catheter survival in a minority of the patients.

Radiologically Placed Tunneled Hemodialysis Catheters: A Single Pediatric Institutional Experience of 120 Patients

PurposeTo report the outcome of tunneled dialysis catheter insertion in 120 patients. Materials and MethodsA retrospective review of the interventional radiology database and electronic medical records of 120 patients who had tunneled dialysis catheters inserted from April 1997 to July 2010 was performed with institutional review board approval. There were 61 female patients and 59 male patients, with a mean age of 13.3 years (range, 0.2–28.5 y). A total of 193 primary insertions and 330 salvage procedures were performed. ResultsThe technical success rate for primary catheter insertions was 100%. Immediate complications included self-limiting tract bleeding and air embolism in two of 193 insertions each (1.03%). Mean indwell duration for primary insertions was 66 catheter-days (range, 1–765 d), compared with a total mean of 159.4 catheter-days (range, 1–1,034 d). Rates of infection and mechanical complications were 0.21 and 0.9 per 100 total catheter-days, respectively. Mechanical and infections complications were increased in children younger than 9 years of age and weighing less than 20 kg. The catheter removal rates for infection and mechanical complications were 0.084 and 0.081 per 100 catheter-days, respectively. Medical salvage procedures, ie, intracatheter thrombolytic agent use or antibiotic therapy (52.1%) and interventional radiologic catheter salvage procedures (47.1%), increased catheter survival by an average of 54.8 days (range, 0–959 d). ConclusionsRadiologic placement of tunneled hemodialysis catheters is a safe and technically successful procedure in pediatric patients. However, there is a high rate of infectious and mechanical complications, particularly in younger and smaller patients.

Efficacy and Safety of a 4% Sodium Citrate Locking Solution in Cuffed Tunneled Hemodialysis Catheters Compared With Heparin

Efficacy and Safety of a 4% Sodium Citrate Locking Solution in Cuffed Tunneled Hemodialysis Catheters Compared With Heparin

Comparison of the Palindrome vs. Step‐Tip Tunneled Hemodialysis Catheter: A Prospective Randomized Trial

Numerous designs for tunneled hemodialysis catheter have been developed in an effort to improve catheter function and survival. In this prospective randomized controlled study, 97 patients were randomized into the palindrome catheter group (PC, n = 47) and step-tip catheter group (SC, n = 50). Demographic characteristics were not different between the two groups. The effective blood flow rates at different pump speeds were comparable between the two groups. The recirculation was low within acceptable range in both types of catheter, and hemodialysis adequacy was not different between the two groups. However, when arterial and venous blood lines were reversed, while the recirculation was significantly increased in SC, it was not increased at all in PC. The catheter dysfunction-free survival rate was significantly higher in PC than in SC (78.9% vs. 54.4% at 2 months, p = 0.008). The overall catheter survival rate was also higher in PC than in SC (90.6% vs. 68.8% at 2 months, p = 0.015). We conclude that both catheters are equally effective on the adequate hemodialysis and low recirculation. However, the PCs have advantages over the SCs in terms of lower catheter dysfunction rate, lower recirculation with reversed blood lines, higher short-term catheter survival rate.

Transvenous Cardiac Implantable Electronic Devices and Hemodialysis Catheters: Recommendations to Curtail a Potentially Lethal Combination

Abnormal renal function is an independent risk factor for cardiac implantable electronic device (CIED) infection. The risk of CIED infection increases as the degree of renal dysfunction worsens with the highest risk observed in patients with stage V chronic kidney disease. A significant portion of these patients use a tunneled hemodialysis catheter (TDC) for dialysis therapy. These devices are associated with very high rates of catheter-related bacteremia (1.6-5.5 episodes of bacteremia per 1000 catheter days), and have been known to cause infection of CIED indwelling in the bloodstream. In this context, the cardiac device is exposed to the risk of infection due to the presence of renal failure and episodes of bacteremia related to TDCs. Both increase the risk of CIED infection. Once infected, a cardiac rhythm device carries a marked increase in morbidity and mortality. In this context, the combination of a TDC and a CIED indwelling in the bloodstream becomes a potentially deadly combination. Recent data have emphasized that epicardial CIED implantation reduces cardiac device infection in TDC patients. This report highlights the risk of CIED infection in renal patients, presents TDC's contribution to the cardiac device infection, and suggests recommendations to minimize the risk of CIED infection in chronic hemodialysis patients dialyzing with a TDC.

Insertion of Permanent Hemodialysis Catheters through the Great Saphenous Vein

In patients with end stage renal disease when there is inability for the creation of a direct arterio-venous fistula or by using a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of hemodialysis. We present a technique of placing a permanent catheter in the inferior vena cava through the great saphenous vein without the use of a guide wire. Over the study period, 12 hemodialyzed patients, with a mean age of 73 years, were referred for placement of a dialysis catheter through the great saphenous veins. The procedure was performed under local anesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunneled hemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire. The hemodialysis catheter's function was assessed intraoperatively. No intraoperative or immediate post operative complications were noted while during the study period 3 thromboses and an infection were detected (0,95 per 1000 catheter days). The primary catheter patency rates were 92%, 84%, 54% at 30, 90 and 180 days respectively, varying from 28 to 845 days (mean±SD = 294 ± 243,3). The introduction of dialysis catheters in the inferior vena cava through the great saphenous vein is technically simple with rare complications and with higher patency rates compared to the traditional femoral approach.

Locking Tunneled Hemodialysis Catheters with Hypertonic Saline (26% NaCl) and Heparin to Prevent Catheter-Related Bloodstream Infections and Thrombosis: A Randomized, Prospective Trial

Objective: Tunneled cuffed dual-lumen catheters (TCCs) are commonly used for vascular access in hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the major problem leading to morbidity and mortality. We investigated whether 26% NaCl solution has any favorable effect on the infections and thrombosis caused by HD catheters. Methods: TCCs were locked with either 26% NaCl and heparin or standard heparin. The primer end point of the study was the CRBSI or thrombosis of the TCC. We compared the antimicrobial activity of the NaCl solutions (6.5%, 13%, 26%) with 0.9% NaCl solution by time–kill kinetic assay. All tests were performed in triplicate by incubation of test fluids with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. Results: The mean catheter survival was significantly higher in the 26% NaCl and heparin group (129.5 ± 50.1 catheter days to 103.3 ± 59.8, p = 0.008). CRBSI rates (10–15.4%) did not differ significantly between the two groups (p = 0.54). The hypertonic 13% NaCl solution had bactericidal effects on E. coli and P. aeruginosa, but had bacteriostatic effect on S. aureus and S. epidermidis. Conclusion: In this study we demonstrated that the 13% NaCl solution and more hypertonic NaCl solutions revealed potent in vitro antimicrobial properties against all checked Gram-negative microorganisms.

Endogenous endophthalmitis as a complication of sepsis related to a tunnelled haemodialysis catheter.

Endogenous endophthalmitis as a complication of sepsis related to a tunnelled haemodialysis catheter.

Hemodiyaliz Hastalarında Ultrasonografi Eşliğinde Kalıcı Tünelli Kateter Uygulamalarımız

Hemodiyaliz Hastalarında Ultrasonografi Eşliğinde Kalıcı Tünelli Kateter Uygulamalarımız

901 Hastada 1419 Kalıcı Tünelli Hemodiyaliz Kateteri Tecrübemiz Işığında Skopi ve Doppler Ultrason Kullanılmasının Erken ve Geç Dönem Sonuçlar Üzerine Etkisi

901 Hastada 1419 Kalıcı Tünelli Hemodiyaliz Kateteri Tecrübemiz Işığında Skopi ve Doppler Ultrason Kullanılmasının Erken ve Geç Dönem Sonuçlar Üzerine Etkisi

Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Mean catheter primary patency failure time was 96.3days (SE 17.9days). Primary patency at 30, 60, 90, and 180days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p=0.009), were of increasing age at the time of insertion (p=0.002) and that those who had diabetes (p=0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

Insertion of Permanent haemodialysis catheters through the great saphenous vein

Aim-BackgroundIn patients with end stage renal disease when there is inability or contraindication for the creation of a direct arterio-venous fistula or the use of a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of haemodialysis. We present a technique of placing a permanent haemodialysis catheter in the inferior vena cava through the great saphenous vein. The aim of this study is to show that the above technique is simply, safe and reliable.Patients-MethodsOver the study period, from January 2002 to December 2010, 12 haemodialyzed patients, (8 females and 4 males), with a mean age of 73 years (range 62–91 years), were referred from different renal units for placement of a dialysis catheter through the great saphenous veins. In all patients, the alternative sites of a permanent haemodialysis catheter insertion in the major branches of the superior vena cava had been extensively used. The procedure was performed under local anaesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunnelled haemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire.ResultsThe haemodialysis catheter’s function was assessed intraoperatively (blood flow>350 ml/min). No intraoperative or immediate post operative complications were noted. The primary catheter patency duration was recorded, which varied from 28 to 845 days (mean±SD=294±243,3).ConclusionThe introduction of dialysis catheters into the inferior vena cava through the great saphenous vein is technically simple with rare complications and with highly successful results.

Repair of Damaged Connectors of Tunneled Cuffed Catheters with a Two-Piece Adaptor for Peritoneal Dialysis

Although catheter use exposes the patient to several complications, tunneled cuffed catheters are widely applied for temporary or long-term vascular access. The aim of the study was to establish the rate of tunneled dialysis catheter damage and report our experience with breakage repair. All 363 cuffed tunneled hemodialysis catheters inserted into 309 patients from May 2000 to December 2008 were followed up. When connector damage was encountered, repair with a two-piece adaptor for peritoneal dialysis was attempted. Mechanical breakage occurred in 33 (9.1%) of catheters with an incidence of 0.36/1000 catheter-days. The most frequent was connector damage, found in 25 cases (67.6%). Catheter repair using a peritoneal dialysis Luer adaptor was performed with good early and long-term outcome. Tunneled catheter breakage is a relatively rare complication. Catheter repair using the adaptor for peritoneal dialysis is easy to perform, safe, and cost-effective.