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Syska B, Veer AS, Matusik PS, Jarczewski JD, Krzanowska K, Popiela TJ. Malposition of Central Venous Catheter into Coronary Sinus throughout the Persistent Left Superior Vena Cava and Other Complications Related to Catheterization. Diagnostics (Basel) 2024; 14:1038. [PMID: 38786336 PMCID: PMC11119990 DOI: 10.3390/diagnostics14101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients.
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Affiliation(s)
- Barbara Syska
- Students’ Scientific Group, Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Cracow, Poland; (B.S.); (A.S.V.)
| | - Anna S. Veer
- Students’ Scientific Group, Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Cracow, Poland; (B.S.); (A.S.V.)
| | - Patrycja S. Matusik
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Jarosław D. Jarczewski
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, 31-008 Cracow, Poland;
| | - Tadeusz J. Popiela
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Cracow, Poland
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Trebuian CI, Marza AM, Cindrea AC, Petrica A, Onea S, Sutoi D, Barsac C, Crintea-Najette I, Popa D, Chioibas R, Mederle OA. Risk Assessment of Venous Thromboembolism among Septic Shock Patients: Single versus Concurrent Insertion of Central Venous Catheters. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:785. [PMID: 38792968 PMCID: PMC11123159 DOI: 10.3390/medicina60050785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Thrombosis is a serious complication experienced by some hospitalized patients. While concurrent placement of two catheters (CVCs) in the same central vein offers several benefits in clinical settings, we aimed to investigate the role of this procedure in relation to the risk of thrombosis. Materials and Methods: Over a two-year retrospective analysis, we examined 114 patients with septic shock caused by a pulmonary infection, who underwent the insertion of one or more central lines into a central vein during their ICU stay. Logistic regression models were employed to assess the correlation between the Caprini risk score, the placement of two CVCs in the same vein, COVID-19 infection and the risk of venous thromboembolism (VTE). Results: In total, 53% of the patients underwent the concurrent insertion of two CVCs. The placement of two CVCs in the same vein appears to elevate the VTE risk by 2.5 times (95% CI: 1.03-6.12). Logistic regression analysis indicated that hemodialysis catheters amplify the VTE risk by nearly five times, even when accounting for a series of factors (95% CI: 1.86-12.31). Conclusions: Our study suggests that the elevated risk of VTE is likely associated with the insertion of the hemodialysis catheters rather than solely the presence of two concurrent catheters.
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Affiliation(s)
- Cosmin Iosif Trebuian
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Department of Anesthesia and Intensive Care, Emergency County Hospital, 320210 Resita, Romania
| | - Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Alexandru Cristian Cindrea
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania
| | - Stefania Onea
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania;
| | - Dumitru Sutoi
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania;
| | - Claudiu Barsac
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania;
| | - Iulia Crintea-Najette
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Daian Popa
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Raul Chioibas
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
| | - Ovidiu Alexandru Mederle
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
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3
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Behera V, Gireesh Reddy G, Shreedhara CG, Kishan A, Kalra K, Ananthakrishnan R, Subramaniam J, Balasubramaniam J. An Improvised Cost-Effective Repair Technique for Management of Broken Luer Connections of Tunneled Dialysis Catheter and Salvage Existing Catheter. Semin Dial 2024; 37:273-276. [PMID: 38432229 DOI: 10.1111/sdi.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/03/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Mechanical problems like break or crack in Luer connectors or hubs, clamps, and tubings are common non-infectious complications of tunneled dialysis catheters (TDC), which may lead to other TDC complications and the need to insert a new catheter. These can be tackled using TDC repair kits or spare parts, which are often not available, resulting in the insertion of a new TDC that increases morbidity, TDC-related procedures, and healthcare costs. We discuss two cases of broken Luer connections of TDC, which were managed by exchanging the broken Luer connector of TDC with the similar Luer connector of a temporary dialysis catheter. Both the repaired TDCs are thereafter functioning well. This improvised technique provides an easy, effective, long-lasting option that salvages the existing TDC and reduces the cost factor.
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Affiliation(s)
| | | | | | - A Kishan
- Institute of NephroUrology, Bengaluru, India
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Gibyeli Genek D, Alp A, Uyar Gazezoğlu O, Huddam B. Vascular access route venture of the chronic hemodialysis patient: A prospective cohort study. Vascular 2024:17085381241244867. [PMID: 38569483 DOI: 10.1177/17085381241244867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVES This study aimed to collect evidence to improve the arteriovenous fistula practice by investigating vascular access routes and by identifying the factors influencing the preferred types of vascular access routes for the first-time hemodialysis in our center. METHODS We performed an epidemiological, prospective, cohort study. The study included 308 patients, who underwent hemodialysis for the first time between March 2023 and August 2023 in our hemodialysis center. We evaluated biochemical parameters, preferred vascular access routes for the first-time hemodialysis, planned/emergency hemodialysis status, the qualifications of the healthcare provider, who inserted the central venous catheter, if applicable, the presence of hypervolemia, anticoagulant use, nephrology follow-up findings, and in-hospital mortality in all patients and in those, who continued with chronic hemodialysis. RESULTS The number of patients, who continued with chronic hemodialysis, was 167 (54.2%) and a temporary internal jugular central venous catheter was the most commonly preferred vascular access route for the first-time hemodialysis (47.3%). A central venous catheter was most commonly inserted by a nephrologist (53.7%) in chronic hemodialysis patients. Of the patients continuing with chronic hemodialysis, 45.5% were followed up in the nephrology outpatient clinic, 9.6% initiated hemodialysis on a planned basis, and 8.4% initiated hemodialysis with an arteriovenous fistula. A temporary internal jugular central venous catheter was commonly preferred when patients were followed up in the nephrology clinic and when the insertion was performed by a nephrologist; a transient femoral central venous catheter was commonly preferred in case of hypervolemia (p < .001, p < .001, and p = .028, respectively). Age, gender, etiology, anticoagulant use, or biochemical test results did not act on the selection of the access site for the insertion of central venous catheter at the time of the first hemodialysis treatment. The access site for central venous catheter was not associated with in-hospital mortality (p = .644). In the overall patient group, the in-hospital mortality was significantly low in patients followed up in the nephrology clinic (p = .014). CONCLUSION The use of pre-emptive arteriovenous fistula for the first hemodialysis treatment occurs much less commonly than expected. Hemodialysis initiation rates with pre-emptive arteriovenous fistula lag behind nephrology outpatient follow-up rates.
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Affiliation(s)
- Dilek Gibyeli Genek
- School of Medicine, Department of Nephrology, Mugla Sitki Kocman University, Mugla, Turkey
| | - Alper Alp
- School of Medicine, Department of Nephrology, Mugla Sitki Kocman University, Mugla, Turkey
| | - Okşan Uyar Gazezoğlu
- Training and Research Hospital, Hemodialysis, Mugla Sitki Kocman University, Mugla, Turkey
| | - Bülent Huddam
- School of Medicine, Department of Nephrology, Mugla Sitki Kocman University, Mugla, Turkey
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5
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Prasad P, Vachharajani TJ. Dialysis Catheter Tip Design and Dysfunction: An Unsolved Challenge. Am J Kidney Dis 2024; 83:429-431. [PMID: 38363257 DOI: 10.1053/j.ajkd.2024.01.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Pallavi Prasad
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India; Department of Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tushar J Vachharajani
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; Wayne State University School of Medicine, Detroit, Michigan.
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Harvey JJ, Vrazas JI, Bekhit E, Barnes C, Robinson PJ. Catheter-related superior vena cava syndrome: an increasing problem. Med J Aust 2024; 220:238-240. [PMID: 38357991 DOI: 10.5694/mja2.52233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Affiliation(s)
- John J Harvey
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - John I Vrazas
- Royal Children's Hospital Melbourne, Melbourne, VIC
- St Vincent's Private Hospital, Melbourne, VIC
| | | | - Chris Barnes
- Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Philip J Robinson
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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7
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Wang Z, Wang K, Xu Y. Friction injury of the central vein caused by catheter for hemodialysis: an in vitro study. Sci Rep 2024; 14:5836. [PMID: 38462667 PMCID: PMC10925602 DOI: 10.1038/s41598-024-56485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
Vascular injury such as central venous stenosis (CVS) is a common complication in hemodialysis patients with central venous catheters (CVCs), yet the impact of the microstructure and partial physic characteristics of catheter surface on the chronic injury of central vein has not been elucidated. In this study, the microscopic morphology of tips and bodies of six different brands of polyurethane CVCs was observed and their roughness was assessed. Subsequently, an in vitro model was established to measure the coefficients of friction (COF) between CVCs (tips and bodies) and the vena cava intima of Japanese rabbits under the same condition in a linear reciprocating mode, and changes in the intima of vessels after friction were observed. The study found that there was a significant variation in surface roughness among different brands of CVCs (tips P < 0.001, bodies P = 0.02), and the COF was positively correlated with the catheter surface roughness (tips P = 0.005, R = 0.945, bodies P = 0.01, R = 0.909). Besides, the endovascular roughness increased after friction. These findings suggest that the high roughness surface of CVCs may cause chronic mechanical friction injury to the central venous intima, which is one of the potential factors leading to CVS or occlusion. This provides a breakthrough for reducing complications, improving patient prognosis, and advancing catheter surface lubrication technology.
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Affiliation(s)
- Zhaoxing Wang
- Department of Nephrology, Emergency General Hospital, Beijing, 100028, China
| | - Kunpeng Wang
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, 200444, China.
| | - Yan Xu
- Department of Nephrology, Emergency General Hospital, Beijing, 100028, China.
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Cruz-Centeno N, Stewart S, Marlor DR, Rivard DC, Daniel JM, Oyetunji TA, Hendrickson RJ. Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy. Am Surg 2024; 90:216-219. [PMID: 37609992 DOI: 10.1177/00031348231198119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) may require renal replacement therapy even after decannulation. However, data regarding transition from ECMO cannulation to a hemodialysis catheter in pediatric patients is not currently available. METHODS Patients <18 years old who had an ECMO cannula exchanged for a hemodialysis catheter during decannulation at a tertiary care children's center from January 2011 to September 2022 were identified. Data was collected from the electronic medical record. RESULTS A total of 10 patients were included. The cohort was predominantly male (80.0%, n = 8) with a median age of 1 day (IQR 1.0, 24.0). All ECMO cannulations were veno-arterial in the right common carotid artery and internal jugular vein. The median time on ECMO was 8.5 days (IQR 6.0, 15.0). One patient had the venous cannula exchanged for a tunneled hemodialysis catheter during decannulation, two were transitioned to peritoneal dialysis, and seven had the temporary hemodialysis catheter converted to a tunneled catheter by Interventional Radiology (when permanent access was required) at a median time of 10 days (IQR 8.0, 12.5). Of these 7 patients, 28.6% (n = 2) developed catheter-associated infection within 30 days of replacement, with one requiring catheter replacement. Transient bloodstream infection occurred in 10.0% (n = 1) within 30 days of ECMO cannula exchange. CONCLUSION Venous ECMO cannula exchange for a hemodialysis catheter in children requiring renal replacement therapy after decannulation is possible as a bridge to a permanent hemodialysis or peritoneal catheter if renal function does not recover, while supporting vein preservation.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Douglas C Rivard
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - John M Daniel
- Department of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
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9
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Zhao QY, Li Q, Cui TL. Risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2024; 12:101682. [PMID: 37708936 DOI: 10.1016/j.jvsv.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We analyzed the risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome (SVCS) and effectiveness of endovascular intervention in hypotension related to SVCS. METHODS This was a retrospective cohort study. A total of 194 maintenance hemodialysis patients diagnosed with SVCS who were admitted to the Department of Nephrology, West China Hospital of Sichuan University from January 2019 to December 2021 were selected and divided into a hypotension group and a nonhypotension group. Demographic and clinical data were compared. Hypotension simply refers to blood pressure levels of <90/60 mm Hg on a nondialysis day. All patients received endovascular intervention. RESULTS Hypotension was found in 85 of the 194 patients. The following factors were significantly different between the hypotension and nonhypotension groups: body mass index, history of hypertension, tunneled-cuffed catheter as the means of dialysis access, azygos ectasis, SVC stenosis of >70% or occlusion, occlusion at the cavitary junction, serum calcium, diastolic left ventricular (LV) posterior wall thickness, LV end-diastolic volume, stroke output, and LV ejection fraction. Multivariate logistic regression analysis showed that hypertension history (OR, 0.314; P = .027), tunneled-cuffed catheter as vascular access (OR, 3.997; P < .001), SVC stenosis of >70% or occlusion (OR, 5.243; P < .001), LV posterior wall thickness (OR, 0.772; P = .044), and serum calcium (OR, 0.146; P = .005) were independent risk factors for hypotension. The mean values of systolic and diastolic blood pressure after intravascular treatment were significantly elevated from those before intervention (P < .001). The primary patency rates of SVC were 66.8%, 58.7%, and 50.0% at 3, 6, and 12 months after the procedure. CONCLUSIONS The incidence of hypotension in patients with hemodialysis-associated SVCS is high. The identification of risk factors of hemodialysis-related hypotension provides insight into potential treatment strategies. Endovascular treatment is expected to improve hypotension related to SVCS in hemodialysis patients.
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Affiliation(s)
- Qiu-Yan Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qiu Li
- Department of Nephrology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Tian-Lei Cui
- Department of Nephrology, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
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10
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Prasad P, Vachharajani TJ. Non-Fluoroscopic Techniques to Insert a Tunneled Hemodialysis Catheter. Kidney Int Rep 2023; 8:2191-2193. [PMID: 38025226 PMCID: PMC10658409 DOI: 10.1016/j.ekir.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Pallavi Prasad
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tushar J. Vachharajani
- Department of Medicine, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
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11
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Harduin LDO, Barroso TA, Guerra JB, Filippo MG, de Almeida LC, de Castro-Santos G, Oliveira FAC, Cavalcanti DET, Procopio RJ, Lima EC, Pinhati MES, dos Reis JMC, Moreira BD, Galhardo AM, Joviliano EE, de Araujo WJB, de Oliveira JCP. Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230052. [PMID: 38021275 PMCID: PMC10648056 DOI: 10.1590/1677-5449.202300522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.
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Affiliation(s)
- Leonardo de Oliveira Harduin
- Universidade Estadual do Estado do Rio de Janeiro - UERJ, Departamento de Cirurgia Vascular, Niterói, RJ, Brasil.
| | | | | | - Marcio Gomes Filippo
- Universidade Federal do Rio de Janeiro - UFRJ, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
| | | | - Guilherme de Castro-Santos
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | - Ricardo Jayme Procopio
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | | | - Barbara D’Agnoluzzo Moreira
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | | | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Departamento de Anatomia e Cirurgia, Ribeirão Preto, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Departamento de Angioradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
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12
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Garcia-Medina J, Garcia-Alfonso JJ. Comparison of Clinical Performance Between Two Types of Symmetric-Tip Haemodialysis Catheters: A Single-Centre, Randomized Trial. Cardiovasc Intervent Radiol 2023; 46:1434-1435. [PMID: 37658235 DOI: 10.1007/s00270-023-03525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/22/2023] [Indexed: 09/03/2023]
Affiliation(s)
- José Garcia-Medina
- Vascular and Interventional Radiology Unit, Reina Sofia Hospital, Intendente Jorge Palacios sn, 30003, Murcia, Spain.
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13
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Cahalane AM, Irani Z, Cui J. Beyond the Veins: Uncovering the History and Advancements of Vascular Access. KIDNEY360 2023; 4:1150-1154. [PMID: 37322593 PMCID: PMC10476679 DOI: 10.34067/kid.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Alexis M. Cahalane
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zubin Irani
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jie Cui
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- Nephrology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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14
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Canaud B, Leray-Moragues H, Chenine L, Morena M, Miller G, Canaud L, Cristol JP. Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter. J Clin Med 2023; 12:4732. [PMID: 37510847 PMCID: PMC10381463 DOI: 10.3390/jcm12144732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Tunneled central venous catheters (CVC) are mainly considered as a rescue vascular access option in dialysis but are still used on approximately one quarter of prevalent patients worldwide even though they are associated with poor performances and higher risks. STUDY DESIGN in this retrospective single-center study, we aimed to report on the clinical performances achieved with high-flow tunneled CVCs (DualCath or DCath) and compared them with arteriovenous accesses (AVAs, e.g., AV fistula, AV graft, and Thomas Shunt) in a hospital-based dialysis unit. METHODS Sixty-eight stage 5 chronic kidney disease dialysis-dependent patients (CKD5D) receiving high volume hemodiafiltration were followed-up with for 30 months. The study consisted of two phases: baseline cross-sectional and longitudinal follow-ups of key performance indicators. Clinical performances consisting of effective blood flow and blood volume, recirculation, urea and ionic Kt/V, total Kt, ultrafiltration volume, and percent reduction in β2-M were measured monthly as part of quality control in our unit. RESULTS At baseline, the effective blood flow using a DCath was close to 400 mL/min, similar to an AVA. Recirculation with a DCath (7%, 6-13%) was higher than with an AVA. The diffusive dialysis dose delivered with a DCath (spKt and eKt/V) and convective dialysis dose achieved with a DCath were slightly lower than those achieved with AVAs, but they were still much higher than is recommended by guidelines. The percent reduction in β2-M achieved with a DCath was also 4 to 10% lower than that achieved with an AVA. On longitudinal follow-up, the main clinical performance indicators of DCaths (total Kt and total ultrafiltration volume, L/session) were maintained as very stable over time and close to those achieved with AVAs. CONCLUSIONS As shown in this study, high-flow DualCath tunneled two-single-lumen silicone catheters may be used to deliver high volume hemodiafiltration in a reliable and consistent manner without compromising clinical performance. These results relied on the specific design of the two silicone cannulas and the strict adherence to best catheter practices.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, 34090 Montpellier, France
- MTX Consulting International, Rue des Carmelites, 34090 Montpellier, France
| | - H Leray-Moragues
- AIDER-Santé, CHARLES, Mion Foundation, 34000 Montpellier, France
| | - Leila Chenine
- Nephrology, Intensive Care, Dialysis & Transplantation, Lapeyronie University Hospital, 34090 Montpellier, France
| | - Marion Morena
- PhyMedExp, Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - George Miller
- Medical Components, Inc., Clinical Affairs, Harleysville, PA 19438, USA
| | - Ludovic Canaud
- Chest and Vascular Surgery Department, CHU Montpellier, 34000 Montpellier, France
| | - Jean Paul Cristol
- AIDER-Santé, CHARLES, Mion Foundation, 34000 Montpellier, France
- PhyMedExp, Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of Montpellier, University of Montpellier, 34000 Montpellier, France
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15
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Li X, Liu S. Who's to blame for central venous stenosis. Pak J Med Sci 2023; 39:1216. [PMID: 37492289 PMCID: PMC10364258 DOI: 10.12669/pjms.39.4.7559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 07/27/2023] Open
Abstract
doi: https://doi.org/10.12669/pjms.39.4.7559
How to cite this: Li X, Liu S. Who’s to blame for central venous stenosis. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7559
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Affiliation(s)
- Xiaodong Li
- Xiaodong Li, Department of Nephrology, Baoding No. 1 Central Hospital of Hebei Medical University, Baoding, Hebei, China
| | - Shuangyan Liu
- Shuangyan Liu, Graduate School of Hebei Medical University, Shijiazhuang 050017, Hebei, China
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16
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Borgquist O, Naddi L, Božović G, Hellberg M, Annborn M, Sjövall F, Adrian M, Hettinger E, Sjöberg P, Kander T. Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter: study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial. Trials 2023; 24:327. [PMID: 37173715 PMCID: PMC10176902 DOI: 10.1186/s13063-023-07350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The right internal jugular vein is currently recommended for temporary central dialysis catheters (tCDC) based on results from previous studies showing a lower incidence of central vein stenosis compared to the subclavian vein. Data is however conflicting, and there are several advantages when the subclavian route is used for tCDCs. This prospective, controlled, randomised, non-inferiority study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes. METHODS Adult patients needing a tCDC will be included from several hospitals and randomised to either subclavian or internal jugular vein catheterisation with a silicone tCDC. Inclusion continues until 50 patients in each group have undergone a follow-up CT venography. The primary outcome is the incidence of post-catheterisation central vein stenosis detected by a CT venography performed 1.5 to 3 months after removal of the tCDC. Secondary outcomes include between-group comparisons of (I) the patients' experience of discomfort and pain, (II) any dysfunction of the tCDC during use, (III) catheterisation success rate and (IV) the number of mechanical complications. Furthermore, the ability to detect central vein stenosis by a focused ultrasound examination will be evaluated using the CT venography as golden standard. DISCUSSION The use of the subclavian route for tCDC placement has largely been abandoned due to older studies with various methodological issues. However, the subclavian route offers several advantages for the patient. This trial is designed to provide robust data on the incidence of central vein stenosis after silicone tCDC insertion in the era of ultrasound-guided catheterisations. TRIAL REGISTRATION Clinicaltrials.gov; NCT04871568. Prospectively registered on May 4, 2021.
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Affiliation(s)
- Ola Borgquist
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.
| | - Leila Naddi
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - Gracijela Božović
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Matthias Hellberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Nephrology, Skåne University Hospital, Lund, Sweden
| | - Martin Annborn
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Fredrik Sjövall
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | - Maria Adrian
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Eva Hettinger
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Pia Sjöberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Thomas Kander
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
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17
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Czajkowski M, Polewczyk A, Jacheć W, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies. Clin Physiol Funct Imaging 2023; 43:47-57. [PMID: 36251514 PMCID: PMC10092861 DOI: 10.1111/cpf.12792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/20/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
Patients requiring temporal or permanent catheter or arterio-venous fistula (AVF) for haemodialysis may be in challenging situation, if they are cardiovascular implantable electronic devices (CIED) carriers. MATERIALS AND METHODS The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. RESULTS A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. CONCLUSION (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free-from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Silesian Medical University , Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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18
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Bartolomeo K, Vachharajani TJ, Shingarev R. The Sisyphean Task of Getting the Arteriovenous Fistula to Mature. KIDNEY360 2021; 2:1873-1875. [PMID: 35419541 PMCID: PMC8986049 DOI: 10.34067/kid.0007452021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
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