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Sivaranjani M, Sanderson H, Nnajide CR, Martens-Koop A, Blondeau JM, Stryker R, White AP. Microbiological analysis of tunneled hemodialysis catheters isolated from patients receiving hemodialysis in Saskatchewan. Future Microbiol 2024; 19:1129-1144. [PMID: 39149853 DOI: 10.1080/17460913.2024.2359879] [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: 02/28/2024] [Accepted: 05/22/2024] [Indexed: 08/17/2024] Open
Abstract
Aim: To compare the microbial communities inside hemodialysis catheters from symptomatic and asymptomatic patients to determine their differences.Materials & methods: Catheters (n = 41) were removed from patients in the Saskatchewan Health Authority over an 18-month period. The catheter section inside the body was flushed and the contents were evaluated using culture-dependent and culture-independent analysis.Results: All catheters were colonized by bacteria, with considerable overlap between groups based on microbial communities and the individual species detected. More Gram-negative species were detected by sequencing, whereas predominantly Gram-positive strains were cultured. Antibiotic resistance and biofilm formation was widespread and not correlated with either catheter group.Conclusion: Common pathogens were detected in each set of catheters, therefore predicting infections based on the microbiology is difficult.
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Affiliation(s)
| | - Haley Sanderson
- Biological Informatics Center of Excellence, Agriculture and Agri-Food Canada, Saskatoon, Saskatchewan, Canada
| | - Chinenye R Nnajide
- Vaccine & Infectious Disease Organization (VIDO), Saskatoon, Saskatchewan, Canada
- Department of Biochemistry, Microbiology & Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anna Martens-Koop
- Vaccine & Infectious Disease Organization (VIDO), Saskatoon, Saskatchewan, Canada
- Department of Biochemistry, Microbiology & Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joseph M Blondeau
- Department of Biochemistry, Microbiology & Immunology, University of Saskatchewan, Saskatoon, SK, Canada
- Division of Clinical Microbiology, Royal University Hospital & Saskatchewan Health Authority (SHA), Saskatoon, SK, Canada
- Department of Pathology & Ophthalmology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rodrick Stryker
- Department of Medicine/Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aaron P White
- Vaccine & Infectious Disease Organization (VIDO), Saskatoon, Saskatchewan, Canada
- Department of Biochemistry, Microbiology & Immunology, University of Saskatchewan, Saskatoon, SK, Canada
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Lazarus B, Polkinghorne KR, Gallagher M, Coggan S, Gray NA, Talaulikar G, Kotwal S. Tunneled Hemodialysis Catheter Tip Design and Risk of Catheter Dysfunction: An Australian Nationwide Cohort Study. Am J Kidney Dis 2024; 83:445-455. [PMID: 38061534 DOI: 10.1053/j.ajkd.2023.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 01/15/2024]
Abstract
RATIONALE & OBJECTIVE Hemodialysis catheter dysfunction is an important problem for patients with kidney failure. The optimal design of the tunneled catheter tip is unknown. This study evaluated the association of catheter tip design with the duration of catheter function. STUDY DESIGN Observational cohort study using data from the nationwide REDUCCTION trial. SETTING & PARTICIPANTS 4,722 adults who each received hemodialysis via 1 or more tunneled central venous catheters in 37 Australian nephrology services from December 2016 to March 2020. EXPOSURE Design of tunneled hemodialysis catheter tip, classified as symmetrical, step, or split. OUTCOME Time to catheter dysfunction requiring removal due to inadequate dialysis blood flow assessed by the treating clinician. ANALYTICAL APPROACH Mixed, 3-level accelerated failure time model, assuming a log-normal survival distribution. Secular trends, the intervention, and baseline differences in service, patient, and catheter factors were included in the adjusted model. In a sensitivity analysis, survival times and proportional hazards were compared among participants' first tunneled catheters. RESULTS Among the study group, 355 of 3,871 (9.2%), 262 of 1,888 (13.9%), and 38 of 455 (8.4%) tunneled catheters with symmetrical, step, and split tip designs, respectively, required removal due to dysfunction. Step tip catheters required removal for dysfunction at a rate 53% faster than symmetrical tip catheters (adjusted time ratio, 0.47 [95% CI, 0.33-0.67) and 76% faster than split tip catheters (adjusted time ratio, 0.24 [95% CI, 0.11-0.51) in the adjusted accelerated failure time models. Only symmetrical tip catheters had performance superior to step tip catheters in unadjusted and sensitivity analyses. Split tip catheters were infrequently used and had risks of dysfunction similar to symmetrical tip catheters. The cumulative incidence of other complications requiring catheter removal, routine removal, and death before removal were similar across the 3 tip designs. LIMITATIONS Tip design was not randomized. CONCLUSIONS Symmetrical and split tip catheters had a lower risk of catheter dysfunction requiring removal than step tip catheters. FUNDING Grants from government (Queensland Health, Safer Care Victoria, Medical Research Future Fund, National Health and Medical Research Council, Australia), academic (Monash University), and not-for-profit (ANZDATA Registry, Kidney Health Australia) sources. TRIAL REGISTRATION Registered at ANZCTR with study number ACTRN12616000830493. PLAIN-LANGUAGE SUMMARY Central venous catheters are widely used to facilitate vascular access for life-sustaining hemodialysis treatments but often fail due to blood clots or other mechanical problems that impede blood flow. A range of adaptations to the design of tunneled hemodialysis catheters have been developed, but it is unclear which designs have the greatest longevity. We analyzed data from an Australian nationwide cohort of patients who received hemodialysis via a tunneled catheter and found that catheters with a step tip design failed more quickly than those with a symmetrical tip. Split tip catheters performed well but were infrequently used and require further study. Use of symmetrical rather than step tip hemodialysis catheters may reduce mechanical failures and unnecessary procedures for patients.
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Affiliation(s)
- Benjamin Lazarus
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Medicine, Monash University, Clayton, Australia; Department of Nephrology, Monash Health, Clayton, Australia.
| | - Kevan R Polkinghorne
- Department of Medicine, Monash University, Clayton, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia; Department of Nephrology, Monash Health, Clayton, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Sarah Coggan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nicholas A Gray
- Sunshine Coast University Hospital, Birtinya, Australia; University of the Sunshine Coast, Sippy Downs, Australia
| | - Girish Talaulikar
- Department of Nephrology, Canberra Hospital, Garran, Australia; School of Medicine, Australian National University, Acton, Australia
| | - Sradha Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Prince of Wales Hospital, University of New South Wales, Sydney, Australia
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Verma N, Gupta N. Septic Emboli to the Brain Secondary to a Patent Foramen Ovale: A Rare Complication of Internal Jugular Vein Catheter. Cureus 2024; 16:e59419. [PMID: 38826600 PMCID: PMC11140158 DOI: 10.7759/cureus.59419] [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] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
The prolonged use of hemodialysis catheters is associated with several complications with infection being the most common. The increased susceptibility to infections in patients on hemodialysis can be attributed to decreased immunity, though age, other comorbidities, and properties of the catheter act as modifiers. Hematogenous spread of the infection can lead to sepsis and seeding into other organs. In this article, we report an unusual case of septic emboli to the brain in a 30-year-old male on prolonged use of a right internal jugular vein (IJV) catheter for hemodialysis. An interesting finding in the case was the presence of a patent foramen ovale (PFO), a persisting embryonic structure that allows right-to-left shunting. It is suspected that this PFO led to the passage of septic emboli from the right IJV site to the brain. Before our case, septic emboli to the brain have been reported to occur from valvular vegetation in case of infective endocarditis. The mainstay of managing patients with septic emboli is the use of antibiotics; additional interventions may be needed on a case-to-case basis.
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Affiliation(s)
- Nikhil Verma
- Oncology, Metro Heart Institute With Multispeciality, Faridabad, IND
| | - Nimish Gupta
- Nephrology, Metro Heart Institute With Multispeciality, Faridabad, IND
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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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Schamroth Pravda M, Maor Y, Brodsky K, Katkov A, Cernes R, Schamroth Pravda N, Tocut M, Zohar I, Soroksky A, Feldman L. Blood stream Infections in chronic hemodialysis patients - characteristics and outcomes. BMC Nephrol 2024; 25:3. [PMID: 38172734 PMCID: PMC10763456 DOI: 10.1186/s12882-023-03442-5] [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: 06/30/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Bloodstream Infections (BSI) are a major cause of death and hospitalization among hemodialysis (HD) patients. The rates of BSI among HD patients vary and are influenced by local patient and pathogen characteristics. Modifications in local infection prevention protocols in light of active surveillance of BSI has been shown to improve clinical outcomes. The aim of this study was to further explore factors associated with BSI in a contemporary cohort of HD patients at a public teaching hospital dialysis center in Israel. METHODS This was a retrospective cohort study of HD patients with a BSI in the years 2014 to 2018. The primary outcome was the occurrence of BSI. Secondary outcomes were to describe the causative pathogens of BSI, and to assess for risk factors for BSI, and mortality. RESULTS Included were 251 patients. The mean age was 68.5 ± 13.4 years, 66.9% were male. The mean time from initiation of dialysis was 34.76 ± 40.77 months, interquartile range (IQR) 1-47.5 months and the follow up period of the cohort was 25.17 ± 15.9 months. During the observation period, 44 patients (17.5%) developed 54 BSI events, while 10 of them (3.9% of the whole cohort) developed recurrent BSI events. Gram-negative microorganisms caused 46.3% of all BSI events. 31.4% of these BSI were caused by resistant bacteria. In a multivariate logistic regression analysis, patients receiving dialysis through a central line had a significantly increased risk for BSI adjusted Odds Ratio (aOR) 3.907, p = 0.005, whereas patients' weight was mildly protective (aOR 0.971, p = 0.024). CONCLUSIONS We noted an increased prevalence of gram-negative pathogens in the etiology of BSI in HD patients. Based on our findings, additional empirical antibiotics addressing gram negative bacteria have been added to our empirical treatment protocol. Our findings highlight the need to follow local epidemiology for implementing appropriate preventative measures and for tailoring appropriate empiric antibiotic therapy.
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Affiliation(s)
- Miri Schamroth Pravda
- Department of Intensive care medicine, E. Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel.
- Department of Internal medicine C, E. Wolfson Medical Center, Holon, Israel.
| | - Yasmin Maor
- Department of Infectious Diseases, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Konstantin Brodsky
- Department of Internal medicine D, E. Wolfson Medical Center, Holon, Israel
| | - Anna Katkov
- Department of Nephrology and Hypertension, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Relu Cernes
- Department of Nephrology and Hypertension, E. Wolfson Medical Center, Holon, Israel
| | | | - Milena Tocut
- Department of Internal medicine C, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Zohar
- Department of Infectious Diseases, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Soroksky
- Department of Intensive care medicine, E. Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Feldman
- Department of Nephrology and Hypertension, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fan Y, He D, Cheng J, Wu Z, Hao Y, Liu H. Successful Removal and Replacement of a Stuck Hemodialysis Catheter via Thoracotomy: Report of Two Cases and Literature Review. Case Rep Nephrol Dial 2024; 14:56-63. [PMID: 38571812 PMCID: PMC10990479 DOI: 10.1159/000537740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Stuck tunneled central venous catheters (CVCs) have been increasingly reported. In rare cases, the impossibility of extracting the CVC from the central vein after regular traction is the result of rigid adhesions to the surrounding fibrin sheath. Forced traction during catheter removal can cause serious complications, including cardiac tamponade, hemothorax, and hemorrhagic shock. Knowledge and experience on how to properly manage the stuck catheter are still limited. Case Presentation Here, we present two cases that highlight the successful removal of the stuck tunneled CVC via thoracotomy through the close collaboration of multidisciplinary specialists in the best possible way. Both patients underwent an unsuccessful attempt at thrombolytic therapy with urokinase, catheter traction under the guidance of digital subtraction angiography and intraluminal balloon dilation. And we reviewed the literature on stuck catheters in the hope of providing knowledge and effective approaches to attempted removal of stuck catheters. Conclusion There is no standardized procedure for dealing with stuck catheters. Intraluminal percutaneous transluminal angioplasty should be considered as the first-line treatment, while open surgery represents a second option only in the event of failure. Care must be taken that forced extubation can cause patients life-threatening.
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Affiliation(s)
- Yanqin Fan
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dejiao He
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Cheng
- Division of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenzhong Wu
- Division of Interventional Radiography, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiqun Hao
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Liu
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
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Herur S, Niranjan M, Bukka VC, Tiwari A, Kinjarapu SN, Murugan P, Gudithi S. Metastatic Thyroid Abscess: A Rare Presentation of Catheter-related Bloodstream Infection in an End-Stage Kidney Disease Patient on Hemodialysis. Indian J Nephrol 2023; 33:482-483. [PMID: 38174309 PMCID: PMC10752408 DOI: 10.4103/ijn.ijn_82_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Siddharth Herur
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - M Niranjan
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vijay C. Bukka
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ankit Tiwari
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Srinivas N. Kinjarapu
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Prasanna Murugan
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Swarnalatha Gudithi
- Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Choi TJ, Carrato KA, Sabri SS, Tabori NE, Sivananthan G. Balloon-Targeted Extra-Anatomic Sharp Recanalization Technique to Re-establish Supraclavicular Vascular Access. J Vasc Interv Radiol 2023; 34:1676-1679. [PMID: 37414213 DOI: 10.1016/j.jvir.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
A balloon-targeted extra-anatomic sharp recanalization (BEST) technique was investigated to re-establish supraclavicular vascular access in patients with central venous occlusion. Query of the authors' institution's database yielded 130 patients who underwent central venous recanalization. Of these, a retrospective review of 5 patients with concurrent thoracic central venous and bilateral internal jugular vein occlusions who underwent sharp recanalization using the BEST technique from May 2018 to August 2022 was performed. Technical success was achieved in all cases without major adverse events. Four (80%) of the 5 patients underwent hemodialysis reliable outflow (HeRO) graft placement using the newly established supraclavicular vascular access.
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Affiliation(s)
- Taedo J Choi
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kaitlin A Carrato
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Saher S Sabri
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Nora E Tabori
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Gajan Sivananthan
- Department of Radiology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC.
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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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Hemodynamic Analysis of the Geometric Features of Side Holes Based on GDK Catheter. J Funct Biomater 2022; 13:jfb13040236. [PMID: 36412877 PMCID: PMC9680405 DOI: 10.3390/jfb13040236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Hemodialysis is an important means to maintain life in patients with end-stage renal disease (ESRD). Approximately 76.8% of patients who begin hemodialysis do so through catheters, which play vital roles in the delivery of hemodialysis to patients. During the past decade, the materials, structures, and surface-coating technologies of catheters have constantly been evolving to ameliorate catheter-related problems, such as recirculation, thrombosis, catheter-related infections, and malfunction. In this study, based on the commercial GDK catheter, six catheter models (GDK, GDK1, GDK2, GDK3, GDK4, and GDK5) with different lumen diameters and different geometric features of side holes were established, and computational flow dynamics (CFD) were used to measure flow rate, shear stress, residence time (RT), and platelet lysis index (PLI). These six catheters were then printed with polycarbonate PC using 3D printing technology to verify recirculation rates. The results indicated that: (1) the catheter with a 5.5 mm outer diameter had the smallest average shear stress in the arterial lumen and the smallest proportion of areas with shear stress > 10 pa. With increasing catheter diameter, the shear stress in the tip volume became lower, the average RT increased, and the PLI decreased due to larger changes in shear stress; (2) the catheters with oval-shaped side holes had smaller shear stress levels than those with circular-shaped holes, indicating that the oval design was more effective; (3) the catheter with parallel dual side holes had uniformly distributed flow around side holes and exhibited lower recirculation rates in both forward and reverse connections, while linear multi-side holes had higher shear stress levels due to the large differences in flow around side holes. The selection of the material and the optimization of the side holes of catheters have significant impacts on hemodynamic performances and reduce the probability of thrombosis, thus improving the efficiency of dialysis. This study would provide some guidance for optimizing catheter structures and help toward the commercialization of more efficient HD catheters.
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