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Li Y, Shi Z, Zhao Y, Tan Z, Guo H, Lu Z. Comparative effectiveness and safety among different tip-design hemodialysis long-term catheters: A meta-analysis. J Vasc Access 2024; 25:448-460. [PMID: 35918875 DOI: 10.1177/11297298221115003] [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: 11/15/2022] Open
Abstract
PURPOSE The aim of this meta-analysis is to compare effectiveness and safety among different tip-design long-term hemodialysis (HD) catheters. MATERIALS AND METHODS PubMed, Embase, and Cochrane Library databases were searched until 8 December 2021 to identify randomized controlled trials (RCTs) and cohort studies comparing step-tip, split-tip, or symmetrical-tip design catheters in patients undergoing HD will be included. The Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale were used to evaluate the quality of RCTs and cohort studies. Data extracted from the articles were integrated to determine mean effective blood pump velocity (Qb), blood recirculation rates, secondary patency, catheter-related infection, catheter-related blood stream infection (CRBSI), thrombosis rates, and all-cause mortality for the three tip-designs. We performed meta-analysis on dichotomous outcomes using a random-effects model to evaluate risk ratios (RRs) and 95% confidence intervals (Cls). The effect sizes of continuous outcomes were reported as the mean difference (MD). Sensitivity and subgroup analyses were also performed. The study was registered in the PROSPERO (CRD42021297069). RESULTS Six RCTs and 11 cohort studies of 2617 individuals were included in our meta-analysis, of which 1088 individuals inserted split-tip catheters, 897 individuals inserted step-tip catheters and 650 received symmetrical-tip design catheters. Sym-tip performed better in mean Qb (MD = 43.85, 95% Cl = 18.13-69.56, p = 0.0008) than step-tip. Split-tip had better outcomes vs step-tip in blood recirculation (RR = 3.44, 95% Cl = 2.49-4.39, p < 0.00001). Sym-tip had significantly better outcomes compared with step-tip (RR = 0.28, 95%Cl = 0.09-0.81, Z = 2.34, p = 0.02) and split-tip (RR = 0.19, 95% Cl = 0.09-0.43, p < 0.0001) in thrombotic events. No significant difference was found in secondary patency, infection rates, CRBSI, and all-cause mortality among the three tip-designs. CONCLUSION The sym-tip of tunneled cuffed catheters performed better mean Qb, lower thrombotic events, and lower blood recirculation when blood line reversed, which may have an advantage over other two catheter-tips.
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Affiliation(s)
- Yunfeng Li
- Deparment of Nephrology, The First Hospital of Tsinghua University, Beijing, China
| | - Zhenwei Shi
- Deparment of Nephrology, The First Hospital of Tsinghua University, Beijing, China
| | - Yunyun Zhao
- Department of Nuclear Medicine, Peking University People's Hospital, Beijing, China
| | - Zhengli Tan
- Department of Vascular Surgery, Tongren Hospital of Capital Medical University, Beijing, China
| | - Hongxia Guo
- Deparment of Nephrology, The First Hospital of Tsinghua University, Beijing, China
| | - Zhaoxuan Lu
- Deparment of Nephrology, The First Hospital of Tsinghua University, Beijing, China
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DANANTO C, SEMBIRING YE, SEDIONO PRIBADI OR, TJEMPAKASARI A. Correlation between the position of double-lumen catheter tip with the incidence of recirculation among patients who undergo hemodialysis: a literature review. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2023. [DOI: 10.23736/s1824-4777.22.01551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Anton FI, Rus PA, Hagau N. Monitoring Anticoagulation with Unfractionated Heparin on Renal Replacement Therapy. Which is the Best aPTT Sampling Site? J Crit Care Med (Targu Mures) 2020; 6:159-166. [PMID: 32864461 PMCID: PMC7430360 DOI: 10.2478/jccm-2020-0024] [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: 02/25/2020] [Accepted: 06/26/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Controlled anticoagulation is key to maintaining continuous blood filtration therapies. Objective: The study aimed to compare different blood sampling sites for activated partial thromboplastin time (aPTT) to evaluate anticoagulation with unfractionated heparin (UFH) in continuous renal replacement therapy (CRRT) and identify the most appropriate sampling site for safe patient anticoagulation and increased filter life span. METHOD The study was a prospective observational single-centre investigation targeting intensive care unit (ICU) patients on CRRT using an anticoagulation protocol based on patient characteristics and a weight-based modified nomogram. Eighty-four patients were included in the study. Four sampling sites were assessed: heparin free central venous nondialysis catheter (CVC), an arterial line with heparinised flush (Artery), a circuit access line (Access), and a circuit return line (Postfilter). Blood was sampled from each of four different sites on every patient, four hours after the first heparin bolus. aPTT was determined using a rapid clot detector, point of care device. RESULTS A high positive correlation was obtained for aPTT values between CVC and Access sampling sites (r (84) =0.72; p <0 .05) and a low positive correlation between CVC and Arterial sampling site (r (84) =0.46, p < 0.05). When correlated by artery age, the young Artery (1-3 day old) correlates with CVC, Access and Postfilter (r (45) = 0.74, p >0.05). The aPTT values were significantly higher at Postfilter and Arterial sampling site, older than three days, compared to the CVC sampling site (p<0.05). CONCLUSION Considering patient bleeding risks and filter life span, the optimal sampling sites for safe assessment of unfractionated heparin anticoagulation on CRRT during CVVHDF were the central venous catheter using heparin free lavage saline solution, a heparinised flushed arterial catheter not older than three days, and a circuit access line.
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Affiliation(s)
| | - Paul Adrian Rus
- Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Natalia Hagau
- Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Regina Maria Hospital, Cluj-Napoca, Romania
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Nadolski GJ, Redmond J, Shin B, Shamimi-Noori S, Vance A, Hammelman B, Clark TWI, Cohen R, Rudnick M. Comparison of Clinical Performance of VectorFlow and Palindrome Symmetric-Tip Dialysis Catheters: A Multicenter, Randomized Trial. J Vasc Interv Radiol 2020; 31:1148-1155. [PMID: 32534972 DOI: 10.1016/j.jvir.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/26/2020] [Accepted: 02/01/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare clinical performance of 2 widely used symmetric-tip hemodialysis catheters. MATERIALS AND METHODS Patients with end-stage renal disease initiating or resuming hemodialysis were randomized to receive an Arrow-Clark VectorFlow (n = 50) or Palindrome catheter (n = 50). Primary outcome was 90-d primary unassisted catheter patency. Secondary outcomes were Kt/V ([dialyzer urea clearance × total treatment time]/total volume of urea distribution), urea reduction ratio (URR), and effective blood flow (QB). RESULTS Primary unassisted patency rates with the VectorFlow catheter at 30, 60, and 90 d were 95.5% ± 3.3, 87.2% ± 7.3, and 80.6% ± 9.8, respectively, compared with 89.1% ± 6.2, 79.4% ± 10.0, and 71.5% ± 12.6 with the Palindrome catheter (P = .20). Patients with VectorFlow catheters had a mean Kt/V of 1.5 at 30-, 60-, and 90-day time points, significantly higher than the mean Kt/V of 1.3 among those with Palindrome catheters (P = .0003). URRs were not significantly different between catheters. Catheter QB rates exceeded National Kidney Foundation-recommended thresholds of 300 mL/min at all time points for both catheters and were similar for both catheters (median, 373 mL/min). Catheter failure, ie, poor flow rate requiring guide-wire exchange or removal, within the 90-day primary outcome occurred in 3 VectorFlow subjects and 5 Palindrome subjects (P = .72). Infection rates were similar, with 0.98 infections per 1,000 catheter days for VectorFlow catheters compared with 2.62 per 1,000 catheter days for Palindrome catheters (P = .44). CONCLUSIONS The 90-day primary patency rates of Palindrome and VectorFlow catheters were not significantly different, and both achieved sustained high QB through 90 day follow-up. However, dialysis adequacy based on Kt/V was consistently better with the VectorFlow catheter versus the Palindrome.
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Affiliation(s)
- Gregory J Nadolski
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104.
| | - Jonas Redmond
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
| | | | - Susan Shamimi-Noori
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
| | - Ansar Vance
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
| | - Benjamin Hammelman
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
| | - Timothy W I Clark
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
| | - Raphael Cohen
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
| | - Michael Rudnick
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104
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Nakagawa K, Yamada S, Matsukuma Y, Nakano T, Mitsuiki K. Survival comparison between superficialization of the brachial artery and tunneled central venous catheter placement in hemodialysis patients with heart failure: A retrospective study. Ther Apher Dial 2019; 24:408-415. [PMID: 31730268 DOI: 10.1111/1744-9987.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/31/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
It remains unclear which vascular access provides better survival in hemodialysis patients with heart failure, superficialization of the brachial artery (SBA), or tunneled central venous catheter (TCVC). We retrospectively followed up 60 hemodialysis patients with heart failure who underwent SBA (n = 36) or TCVC placement (n = 24). During the median 2.2-year follow-up period, 36 patients died. The median survival time was significantly longer for the SBA group than for the TCVC group (5.7 vs 1.7 years; P < .05, log-rank test). A multivariate-adjusted Cox regression analysis showed that SBA was associated with a reduced risk of all-cause death (hazard ratio [HR] 0.30; 95% confidence interval [CI] 0.14-0.65). In the cohort of propensity score-matched 15 pairs, patients with SBA experienced fewer all-cause deaths (HR 0.29; 95% CI 0.10-0.77). Our study suggests that SBA is an alternative option in hemodialysis patients with heart failure.
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Affiliation(s)
- Kaneyasu Nakagawa
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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Silverstein DM, Trerotola SO, Clark T, James G, Ng W, Dwyer A, Florescu MC, Shingarev R, Ash SR. Clinical and Regulatory Considerations for Central Venous Catheters for Hemodialysis. Clin J Am Soc Nephrol 2018; 13:1924-1932. [PMID: 30309840 PMCID: PMC6302318 DOI: 10.2215/cjn.14251217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Central venous catheters remain a vital option for access for patients receiving maintenance hemodialysis. There are many important and evolving clinical and regulatory considerations for all stakeholders for these devices. Innovation and transparent and comprehensive regulatory review of these devices is essential to stimulate innovation to help promote better outcomes for patients receiving maintenance hemodialysis. A workgroup that included representatives from academia, industry, and the US Food and Drug Administration was convened to identify the major design considerations and clinical and regulatory challenges of central venous catheters for hemodialysis. Our intent is to foster improved understanding of these devices and provide the foundation for strategies to foster innovation of these devices.
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Affiliation(s)
- Douglas M. Silverstein
- Center for Devices and Radiological Health, Division of Reproductive, Gastro-Renal, and Urological Devices, Renal Devices Branch, US Food and Drug Administration, Silver Spring, Maryland
| | - Scott O. Trerotola
- Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Clark
- Interventional Radiology, Penn-Presbyterian Medical Center, Hospitals of the University of Pennsylvania, , Philadelphia, Pennsylvania
| | - Garth James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
| | - Wing Ng
- Regulatory Affairs and Patient Recovery, Cardinal Health, Inc., Dublin, Ohio
| | - Amy Dwyer
- Internal Medicine and Interventional Nephrology, University of Louisville, Louisville, Kentucky
| | - Marius C. Florescu
- Internal Medicine and Nephrology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Roman Shingarev
- Internal Medicine and Nephrology, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Stephen R. Ash
- Indiana University Health Arnett Hospital, Lafayette, Indiana
- HemoCleanse Technologies, LLC, Lafayette, Indiana; and
- Ash Access Technology, Inc., Lafayette, Indiana
| | - on behalf of the Kidney Health Initiative HDF Workgroup
- Center for Devices and Radiological Health, Division of Reproductive, Gastro-Renal, and Urological Devices, Renal Devices Branch, US Food and Drug Administration, Silver Spring, Maryland
- Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Interventional Radiology, Penn-Presbyterian Medical Center, Hospitals of the University of Pennsylvania, , Philadelphia, Pennsylvania
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
- Regulatory Affairs and Patient Recovery, Cardinal Health, Inc., Dublin, Ohio
- Internal Medicine and Interventional Nephrology, University of Louisville, Louisville, Kentucky
- Internal Medicine and Nephrology, University of Nebraska Medical Center, Omaha, Nebraska
- Internal Medicine and Nephrology, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
- Indiana University Health Arnett Hospital, Lafayette, Indiana
- HemoCleanse Technologies, LLC, Lafayette, Indiana; and
- Ash Access Technology, Inc., Lafayette, Indiana
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Jonczyk M, Althoff C, Slowinski T, Lieker I, Naik M, Auer J, Marcos RG, Duka E, Hamm B, de Bucourt M. Urea-based recirculation validation of the symmetrical palindrome catheter. J Ren Care 2017; 43:242-246. [PMID: 28815975 DOI: 10.1111/jorc.12210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND High blood flow and low recirculation rates are central for adequate haemodialysis. A new symmetrical tip has been invented promising efficient haemodialysis even if the ports are reversed. OBJECTIVE To evaluate access recirculation of the 'palindrome' catheter and to report initial experiences in a clinical setting. MATERIAL AND METHODS After implantation of the new catheter in 20 patients (male: 14; female: 6; mean age 72 ± 12.2), access recirculation was evaluated using the urea-based recirculation test. After 30 minutes of haemodialysis, ultrafiltration was stopped and arterial and venous samples were taken. Afterwards, the blood flow rate was reduced to 120 ml/min. Another systemic arterial blood sample was taken 10 seconds after the blood pump was switched off. RESULTS All 20 interventions were performed successfully without complications. The average recirculation rate was 8.1% with a median of 2.5% ranging from 0 to 85.8%. Recirculation rates under 5% were measured in 13 patients and more than 10% recirculation were found in two patients. The median of days between catheter implantation and recirculation assessment was the day following implantation. CONCLUSION The new symmetrical catheter presented low recirculation rates in a clinical setting. Since there is just a single tip, fluoroscopic placement in the right atrium is facilitated.
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Affiliation(s)
- Martin Jonczyk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Christian Althoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Slowinski
- Department of Nephrology, Charité - Universitätsmedizin, Berlin, Germany
| | - Ina Lieker
- Department of Nephrology, Charité - Universitätsmedizin, Berlin, Germany
| | - Marcel Naik
- Department of Nephrology, Charité - Universitätsmedizin, Berlin, Germany
| | - Jonas Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Raúl García Marcos
- Department of Medical Imaging, Unit of Interventional Radiology, La Fe University and Polytechnic Hospital of Valencia, Valencia, Spain
| | - Ejona Duka
- Department of Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hemodialysis Catheter Tip Design: Observations on Fluid Flow and Recirculation. J Vasc Access 2015; 17:29-39. [DOI: 10.5301/jva.5000463] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose To observe fluid flow patterns and measure recirculation rates of tunneled hemodialysis catheters using a mechanical model that simulates hemodialysis treatment. Materials and methods Nine tunneled hemodialysis catheters were evaluated using a mechanical model that simulated catheter conditions during a routine hemodialysis treatment. Objective and subjective determinants of catheter performance were measured and compared. Catheters were evaluated with blood lines connected in standard and reversed configurations using a fluid flow rate of 425 ml/min. Results With blood lines in standard configuration the Split Cath® was the only catheter to exhibit an atypical fluid flow pattern and significant tip movement. When the blood lines were reversed, three split-tip catheters had significant tip movement. The three step-tip catheters and two symmetric tip catheters had stable fluid flow patterns and no significant tip movement with blood lines connected in standard and reverse configurations. The nine catheters had no recirculation when connected in standard configuration. When the blood lines were reversed the percentage of recirculating fluid for symmetric tip, step-tip, and split-tip catheters was 0%, 15% to 20%, and 20% to 30%, respectively. The Equistream®, Palindrome™, and Symetrex catheters had no recirculation with blood lines connected in standard or reversed configurations. Conclusions Eight of the nine catheters evaluated in this study performed well with blood lines connected in standard configuration. When blood lines were reversed, symmetric tip and step-tip designs had more stable fluid flow patterns, less tip movement and lower recirculation rates when compared to split-tip designs.
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Wilson P, Lertdumrongluk P, Leray-Moragués H, Chenine-Koualef L, Patrier L, Canaud B. Prevention and management of dialysis catheter complications in the intensive care unit. Blood Purif 2012; 34:194-9. [PMID: 23095420 DOI: 10.1159/000341721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dialysis dependence at hospital discharge after acute kidney injury (AKI) requiring renal replacement therapy (RRT) in the intensive care unit (ICU) is found in 10-15% of survivors. In case of severe AKI in the ICU, it is necessary to reconcile two objectives: the creation of an adequate temporary angioaccess for RRT and the preservation of the patient's vascular network in case of evolution to end-stage renal disease. A central venous catheter (CVC) is the best option for RRT in the ICU setting. Most catheter-related hazards can be prevented by following best clinical practices for insertion and handling of the CVC, and by knowing the advantages and disadvantages of the different types of catheters, the sites and techniques of insertion, the types of RRT modality for choosing the best CVC option, and the prophylactic and therapeutic measures to prevent and to manage the complications. We review here some important aspects of the CVC for the treatment of AKI in the ICU.
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Affiliation(s)
- Patrick Wilson
- Nephrology, Dialysis and Intensive Care, Lapeyronie University Hospital - CHU Montpellier, Montpellier, France. pckwilson @ gmail.com
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Hwang HS, Kang SH, Choi SR, Sun IO, Park HS, Kim Y. Comparison of the Palindrome vs. Step-Tip Tunneled Hemodialysis Catheter: A Prospective Randomized Trial. Semin Dial 2012; 25:587-91. [DOI: 10.1111/j.1525-139x.2012.01054.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clark TW, Van Canneyt K, Verdonck P. Computational Flow Dynamics and Preclinical Assessment of a Novel Hemodialysis Catheter. Semin Dial 2012; 25:574-81. [DOI: 10.1111/j.1525-139x.2012.01052.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Caridi J, Ross E, Aspilcueta A, Wiley S. The Cannon Catheter—A Prospective Analysis. J Vasc Interv Radiol 2010; 21:1588-90. [DOI: 10.1016/j.jvir.2010.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 04/16/2010] [Accepted: 05/12/2010] [Indexed: 11/15/2022] Open
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Kovač J, Buturović-Ponikvar J, Ponikvar R. Vascular Access Recirculation in Hemodialysis Patients With Two Noncuffed, Single-lumen, Jugular Catheters in the Same Jugular Vein. Ther Apher Dial 2009; 13:350-3. [DOI: 10.1111/j.1744-9987.2009.00738.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ash SR. REDUCING TUNNELED HEMODIALYSIS CATHETER MORBIDITY: Advances in Tunneled Central Venous Catheters for Dialysis: Design and Performance. Semin Dial 2008; 21:504-15. [DOI: 10.1111/j.1525-139x.2008.00494.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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