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Baykara Ulusan M, Meltem E, Mutlu IN, Ulusan K. The predictive value of systemic inflammatory markers in 902 patients with tunneled hemodialysis catheter. J Nephrol 2024; 37:1041-1049. [PMID: 38512368 PMCID: PMC11239775 DOI: 10.1007/s40620-023-01880-w] [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: 08/17/2023] [Accepted: 12/26/2023] [Indexed: 03/23/2024]
Abstract
AIM This study aimed to assess the predictive role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and mean platelet volume, on catheter survival in chronic hemodialysis patients, analyzing both infectious and non-infectious complications. METHODS A retrospective analysis encompassed 1279 tunneled catheter insertion procedures involving 902 patients between March 2014 and October 2018. Patients were categorized into two main groups: (i) initial placement and (ii) exchange. The exchange group was further stratified into four subgroups: infection, dysfunction, displacement, and transitioning temporary hemodialysis catheters to long-term ones. Hematologic ratios were calculated from baseline hemogram data, including neutrophil, lymphocyte, monocyte, and platelet counts, while mean platelet volume was derived from the same hemogram. RESULTS The patients in the exchange group displayed significantly higher lymphocyte and monocyte values (p < 0.001), while lower values were noted for neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (p < 0.001). The transition group displayed higher monocyte values and lower mean platelet volume and lymphocyte-monocyte ratio values (p < 0.05). In the infection-related exchange subgroup, higher neutrophil count, mean platelet volume, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values were observed compared to other groups (p < 0.05). Cases related to catheter dysfunction exhibited increased lymphocyte-monocyte ratio but lower neutrophil, monocyte, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values (p < 0.05). CONCLUSION This study highlights the interest of specific inflammatory markers, particularly monocytes, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio, in the management of tunneled catheters, notably in patients undergoing exchanges. However, cut-off values, essential for constructing management algorithms, are currently lacking, and prospective multicenter studies are needed for further elucidation.
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Affiliation(s)
- Melis Baykara Ulusan
- Department of Diagnostic and Interventional Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey.
| | - Emine Meltem
- Department of Diagnostic and Interventional Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
| | - Ilhan Nahit Mutlu
- Department of Radiology, Department of Diagnostic and Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Kivilcim Ulusan
- Department of General Surgery, Department of Endocrine Surgery, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
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2
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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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3
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Tayebi P, Hasanzadeh K, Asgharpour M, Bijani A, Ziaie N. A cross-sectional study on non-infectious dysfunction of hemodialysis cuffed catheter. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:439-443. [PMID: 39011440 PMCID: PMC11246692 DOI: 10.22088/cjim.15.3.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/03/2023] [Accepted: 10/25/2023] [Indexed: 07/17/2024]
Abstract
Background Dialysis cuffed catheter dysfunction results in inadequate dialysis, increased sepsis risk, and a shortened catheter life. It may be possible to prolong catheter function by identifying the causes of cuffed catheter dysfunction. Methods This study was a cross-sectional descriptive study conducted in 2021-2022 on hemodialysis patients with jugular cuff catheters. The catheterizations were performed using the Seldinger technique and were confirmed by fluoroscopy. A 12-month follow-up was conducted with respect to the performance of the cuffed catheter. Results A total of 123 patients underwent hemodialysis over 2 years via a cuffed catheter. Catheters were most commonly inserted into the right internal jugular vein, with lengths of 19 cm (tip to cuff). The rate of dysfunction of cuffed catheters was 27.6%. Catheter-related thrombosis was the most common cause in 10 cases (29.4%), followed by catheter tip fibrin sheath in 8 cases (23.5%) and catheter tip malposition in 8 cases (23.5%). Furthermore, 18 patients (52.94%) of cuffed catheter dysfunction occurred within 3 months of catheter placement, based on our study. The dysfunction of cuffed catheters on the left side 23 (67.64%) is more prevalent than the right side 11 (32.35%) (P=0.043); the malposition of catheter tips is more prevalent on the left side (P=0.023). Conclusion Most commonly, cuffed catheter dysfunction is caused by thrombosis, fibrin sheath formation, and catheter tip malposition. Cuffed catheter failure can be reduced by carefully monitoring the catheter's path and tip position, searching for fibrin sheaths when investigating cuffed catheter failure, and preventing thrombotic events.
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Affiliation(s)
- Pouya Tayebi
- Department of Vascular and Endovascular Surgery, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Kosar Hasanzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Masoumeh Asgharpour
- Department of Nephrology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinant of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Naghmeh Ziaie
- Department of Cardiology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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Echefu G, Stowe I, Lukan A, Sharma G, Basu-Ray I, Guidry L, Schellack J, Kumbala D. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. FRONTIERS IN NEPHROLOGY 2023; 3:1280666. [PMID: 38022724 PMCID: PMC10664753 DOI: 10.3389/fneph.2023.1280666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Abdulkareem Lukan
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Gaurav Sharma
- Department of Nephrology, AIIMS Rishikesh, Rishikesh, India
| | - Indranill Basu-Ray
- Department of Cardiology, AIIMS Rishikesh, Rishikesh, India
- Department of Cardiovascular Disease, Memphis Veterans Affairs Medical Center, Memphis, TN, United States
| | - London Guidry
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Jon Schellack
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Damodar Kumbala
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
- Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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5
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Waters M, Huszti E, Ramirez ME, Lok CE. Infectious outcomes of fibrin sheath disruption in tunneled dialysis catheters. J Vasc Access 2023; 24:1091-1098. [PMID: 35001725 PMCID: PMC10631277 DOI: 10.1177/11297298211070690] [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: 01/18/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fibrin sheath (FS) formation around tunneled central venous catheters (CVC) increases the risk of catheter-related bloodstream infections due to bacterial adherence to a biofilm. We sought to investigate whether FS disruption (FSD) at the time of CVC removal or exchange affects infectious outcomes in patients with CVC-related infections. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Retrospective cohort study of 307 adult maintenance hemodialysis patients aged 18 years or older at a single center academic-based hemodialysis program (UHN, Toronto) who developed CVC-related infections requiring CVC removal or exchange between January 2000 and January 2019. Exposure was FSD at the time of CVC removal or exchange. Outcomes were infectious metastatic complications, recurrent infection with the same organism within 1 year, or death due to infection. We created a Markov Multi-State Model (MMSM) to assess patients' trajectories through time as they transitioned between states. A time-to-event analysis was performed, adjusted for clinically relevant factors. RESULTS There was no significant relationship between FSD status at the time of CVC removal, the development of infectious complications in the multivariable model (adjusted HR = 0.71, 95% CI 0.09-5.80, p = 0.76), or mortality from infection (HR = 0.84, 95% CI 0.34-2.11, p = 0.73). CONCLUSIONS FSD at the time of CVC removal was not associated with increased risk of infectious complications or death due to infection. Further prospective study is needed to determine whether FSD contributes to reducing CVC infectious related complications.
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Affiliation(s)
- Mara Waters
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maria Erika Ramirez
- Division of Nephrology, Department of Medicine, St. Luke’s Medical Center, Quezon City, Philippines
| | - Charmaine E. Lok
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Nephrology, Department of Medicine, University Health Network – Toronto General Hospital, Toronto, ON, Canada
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6
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Chenevert L, Truong J. What is causing this dialysis patient's intermittent weakness? JAAPA 2022; 35:63-65. [PMID: 35762960 DOI: 10.1097/01.jaa.0000832620.82159.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Chenevert
- At New York-Presbyterian/Columbia University Irving Medical Center in New York City, Laura Chenevert practices in emergency medicine and Jimmy Truong is an assistant professor of emergency medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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7
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Bogdan L, Malavade T. Tunneled dialysis line-associated hemorrhagic shock following self-inflicted trauma in a hemodialysis patient: A case report. Hemodial Int 2022; 26:E37-E40. [PMID: 35732603 DOI: 10.1111/hdi.13035] [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: 01/28/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Complications of tunneled central venous catheters (CVCs) for hemodialysis are frequent, and most commonly include bacteremia, thrombosis, and stenosis. While bleeding is a relatively rare complication of dialysis lines overall, tunneled CVCs may present a unique bleeding risk given their ability to be displaced or damaged as patients have direct access to the equipment in place. Here, we describe the case of a 68-year-old man with end-stage renal disease and neurocognitive disorder, who developed hemorrhagic shock following self-inflicted laceration of his tunneled dialysis catheter proximal to the Y. Examination of the catheter tunnel revealed that the cuff was palpable proximal to the exit site, but the opening was well retracted. In such cases, hemorrhage is particularly difficult to control because the cuff is rigid and poorly amenable to compression, in addition to being difficult to access. This case demonstrates the risk of significant hemorrhage when a tunneled CVC is damaged at this location and the potential need for the urgent removal of the retained component to prevent recurrence of bleeding. It also highlights important patient safety considerations given the risk of self-inflicted trauma in patients with a neurocognitive disorder and a language barrier affecting communication.
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Affiliation(s)
- Lucia Bogdan
- Department of Internal Medicine, University of Toronto, Toronto, Canada
| | - Tushar Malavade
- Department of Internal Medicine, University of Toronto, Toronto, Canada.,Division of Nephrology, University Health Network, Toronto, Canada
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8
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Hassani M, Mohebbi M, Tavallaei M, Nodoushan SMRH, Mirzadeh M, Hashemi R. May position of hemodialysis catheter tip have a direct effect on its patency? Positive results of a preliminary study on its rotation. Eur J Transl Myol 2022; 32. [PMID: 35587263 PMCID: PMC9295167 DOI: 10.4081/ejtm.2022.10537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Renal transplant therapy is essential in patients with End-Stage Renal Disease (ESRD). It is used in patients awaiting a kidney transplant or those who cannot be a transplant candidate. Central venous catheter is one of the most used access routes worldwide but has been recorded as the one with highest mortality and morbidity rate. Thromboembolic events have played a major part for that. This is a descriptive-analytical study, which conducted in a university treatment center in Tehran, Iran. A total of 225 patients were selected for this study that 108 were excluded because of our criteria. Statistical analysis was performed by SPSS v19 and a total of 117 patients were included in this study. The average age of the patients was 51.62±11.26. 79 (67.5%) and 38 (32.5%) patients had medial and lateral tip direction, respectively. The catheter of 85(72.6%) and 32(27.4%) patients was patent and occluded, respectively. The average catheter tip occlusion time in both groups was 22.5 and 7.5 months. Three-month, six-month, twelve-month, and twenty-four-month patency rate were 99%, 94%, 88%, and 30%, respectively. our findings suggest that medial direction of the tip of the catheter reduces complications caused in CVS. Because our study has been conducted in a small scale and there is lack of similar studies, our team suggests extension to a larger scale to confirm or not our results.
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Affiliation(s)
- Mohammad Hassani
- Department of General Surgery, School of Medicine, Ayatollah Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran.
| | - Mahdi Mohebbi
- Department of General Surgery, School of Medicine, Ayatollah Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran.
| | - Mehdi Tavallaei
- Department of General Surgery, Alborz University of Medical Sciences, Karaj.
| | - Seyed Mohammad Reza Hosseini Nodoushan
- Department of Vascular and Endovascular Surgery, Ayatollah Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran.
| | - Moein Mirzadeh
- Department of General Surgery, School of Medicine, Ayatollah Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran.
| | - Rana Hashemi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran.
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9
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Al-Balas A, Almehmi A, Varma R, Al-Balas H, Allon M. De Novo Central Vein Stenosis in Hemodialysis Patients Following Initial Tunneled Central Vein Catheter Placement. KIDNEY360 2021; 3:99-102. [PMID: 35368564 PMCID: PMC8967595 DOI: 10.34067/kid.0005202021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/11/2021] [Indexed: 01/12/2023]
Abstract
Background Central vein stenosis (CVS) is a common complication in hemodialysis patients following tunneled central venous catheter (CVC) insertion. Little is known about its incidence, association with patient characteristics, or relationship with duration of CVC placement. We systematically evaluated central vein stenosis in hemodialysis patients receiving their first CVC exchange at a large medical center. Methods All new hemodialysis patients underwent an ultrasound before their internal jugular tunneled CVC placement, to exclude venous stenosis or thrombosis. After the initial CVC insertion, if the patients were referred for CVC exchange due to dysfunction, a catheterogram/venogram was performed to assess for hemodynamically significant (≥50%) central vein stenosis. During a 5-year period (January 2016 to January 2021), we quantified the incidence of CVS in patients undergoing CVC exchange. We also evaluated the association of central vein stenosis with patient demographics, comorbidities, and duration of CVC dependence before exchange. Results During the study period, 273 patients underwent exchange of a tunneled internal jugular vein CVC preceded by a catheterogram/venogram. Hemodynamically significant CVS was observed in 36 patients (13%). CVS was not associated with patient age, sex, race, diabetes, hypertension, coronary artery disease, peripheral artery disease, or CVC laterality. However, the frequency of CVS was associated with the duration of CVC dependence (26% versus 11% for CVC duration ≥6 versus <6 months: odds ratio (95% CI), 3.17 (1.45 to 6.97), P=0.003). Conclusions Among incident hemodialysis patients receiving their first tunneled internal jugular CVC exchange, the overall incidence of de novo hemodynamically significant central vein stenosis was 13%. The likelihood of CVS was substantially greater in patients with at least 6 months of CVC dependence.
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Affiliation(s)
- Alian Al-Balas
- Division of Nephrology, University of Alabama at Birmingham, Alabama,Division of Interventional Radiology, University of Alabama at Birmingham, Alabama
| | - Ammar Almehmi
- Division of Nephrology, University of Alabama at Birmingham, Alabama,Division of Interventional Radiology, University of Alabama at Birmingham, Alabama
| | - Rakesh Varma
- Division of Interventional Radiology, University of Alabama at Birmingham, Alabama
| | - Hassan Al-Balas
- Division of Interventional Radiology, Baylor College of medicine, Houston, Texas,Division of Radiology, Jordan University of Science & Technology, Irbid, Jordan
| | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Alabama
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Parvulescu F, Oliver MJ, Reyna ME, Pugash R, David E. Factors Affecting Cuff Extrusion of Tunneled Hemodialysis Catheters. Can Assoc Radiol J 2021; 73:410-418. [PMID: 34579540 DOI: 10.1177/08465371211041241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To identify patient and procedural factors associated with extrusion of the Dacron cuff from the subcutaneous tunnel of tunneled hemodialysis catheters (THDCs). MATERIALS AND METHODS Single center 5-year retrospective analysis of 625 catheters in 293 adult patients. Patient data included age, gender, body mass index (BMI), and common comorbidities. Procedural details included type of procedure (new insertion vs. exchange), operator seniority, side of insertion, catheter model and presence of catheter wings skin-sutures. Complications were reported as cumulative risk over time and Cox proportional hazards model was used to evaluate risk factors for cuff extrusion (CE). RESULTS Median patient follow-up was 503 days (188,913 catheter-days) and median catheter survival 163 days. CE occurred in 23.8% of catheters, at a rate of 0.79 per 1,000 catheter-days and a median time of 64 days. It was more common than infection (14.6%) and inadequate flow (15.5%). The 1-month and 12-month risk of CE was 5.9% and 21.3% respectively. A first episode of CE was a strong predictor of future CE episodes. The only patient factor that affected the risk of CE was BMI (Hazard Ratio 2.36 for obese patients). Procedural factors that affected the risk of CE, adjusted for BMI, were catheter model, type of procedure (lower risk for new insertions) and catheter wings skin-sutures; the latter reduced the 30-day CE risk by 76% without increasing catheter-related infections. CONCLUSION Cuff extrusion is common in long-term THDCs. The risk increases with obesity, history of previous cuff extrusion, certain catheter models and absence of wing-sutures.
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Affiliation(s)
- Flavius Parvulescu
- Interventional Radiology Department, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Myrtha E Reyna
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Pugash
- Interventional Radiology Department, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Elizabeth David
- Interventional Radiology Department, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Medical malpractice related to dialysis and vascular access: An analysis of lawsuit judgements in South Korea. PLoS One 2021; 16:e0255020. [PMID: 34351955 PMCID: PMC8341505 DOI: 10.1371/journal.pone.0255020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hemodialysis is a life-saving renal replacement treatment for patients with chronic kidney disease, but various complications occur during hemodialysis and associated procedures. This study was conducted to analyze the specific characteristics of hemodialysis-related complications and malpractice that have led to legal disputes. METHODS Judgments from cases litigated between 1991 and 2019 due to complications related to hemodialysis or vascular access were analyzed using the database of the Korean Supreme Court Judgment System. RESULTS Of 32 dialysis-related litigation cases, 14 cases were dismissed and malpractice was recognized in 18 cases. Among all cases and those in which malpractice was recognized, the most common clinical complication was associated with central venous catheter (CVC) insertion (25.0% and 42.9%, respectively). In 22 of 32 (68.8%) cases, complications occurred before or after (not during) dialysis, and performance error was the most common clinical error leading to legal disputes (58.3%). Complications resulted in death in 59.4% of cases, and CVC-related complications were associated with the largest proportion (63.2%) of deaths. CONCLUSIONS Hemodialysis was implicated in various medical disputes, and CVC-related complications were the most common and serious adverse events. Clinicians' awareness of the incidence and severity of possible complications of hemodialysis procedures should be increased.
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12
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Mitropoulou A, Lehmann H, Heier EM, Schneider M, Hassdenteufel E. Life-Threatening Mediastinal Hematoma Formation After Removal of the Hemodialysis Catheter in a Boxer: A Case Report. Front Vet Sci 2021; 8:691472. [PMID: 34291102 PMCID: PMC8287261 DOI: 10.3389/fvets.2021.691472] [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: 04/06/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
A 4-year-old female Boxer was referred for renal replacement therapy 2 days after observed grape ingestion. An 11-French dual-lumen dialysis catheter was placed into the right jugular vein and continuous renal replacement therapy was initiated for 66 h. Afterwards the patient received enoxaparin subcutaneously as a thromboprophylaxis. Four hours after removal of the dialysis catheter the patient developed severe dyspnea with hypercapnia and signs of hemorrhagic shock. Bedside ultrasound and X-rays of the thorax revealed a soft tissue opacity dorsally of the trachea, located in the mediastinum. The findings were consistent with mediastinal bleeding and hematoma formation. Blood gas examination indicated hypoventilation. The dog was managed conservatively with multiple blood transfusions and mechanical ventilation. The patient survived to discharge, and the hematoma was fully absorbed in the radiographs after 17 days. Patients with impaired kidney function should receive individualized enoxaparin dosage adjusted to anti-Xa levels and should be strictly monitored for complications. Mediastinal hemorrhage and hematoma formation should be considered as a potential complication in patients receiving a jugular vein catheter.
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Affiliation(s)
- Athanasia Mitropoulou
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hendrik Lehmann
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Evelyn M Heier
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Matthias Schneider
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Esther Hassdenteufel
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
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13
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Marques J, Duarte TI, Cotovio P, Borges A, Germano N. Hemodialysis catheter heparin lock related bleeding: Hemorrhagic shock every other day. J Vasc Access 2021; 23:455-457. [PMID: 33570006 DOI: 10.1177/1129729821993973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Catheter dysfunction is an important cause of catheter loss. In order to prevent this, locking solutions with minimal risk of systemic anticoagulation are used to ensure catheter patency. At present the most commonly used solutions are either heparin or sodium citrate. According to the literature use of sodium citrate may be advantageous in reducing bleeding events. We report a case of hemorrhagic shock following hemodialysis catheter lock with heparin, reversed after switching solution to sodium citrate.
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Affiliation(s)
- Joana Marques
- Nephrology Department, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Tiago Isidoro Duarte
- Intensive Care Medicine Department, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Patrícia Cotovio
- Nephrology Department, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - André Borges
- Intensive Care Medicine Department, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Nuno Germano
- Intensive Care Medicine Department, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
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14
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Araújo Rocha G, Lima de Oliveira AK, Lima Oliveira FG, Silva Rodrigues VE, de Sousa Moura AG, Barros Sousa E, Gomes Machado AL. Cuidados com o acesso vascular para hemodiálise: revisão integrativa. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.2090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introdução: As complicações relacionadas ao acesso vascular para hemodiálise podem resultar em intervenções complexas, contudo, cuidados adotados pelos profissionais de saúde e pacientes adultos podem evitá-las. Objetivou-se analisar a produção científica acerca dos cuidados com acessos vasculares utilizados na hemodiálise para elaboração do conteúdo de uma cartilha educativa voltada ao autocuidado do paciente. Método: Revisão integrativa de literatura realizada nas bases de dados: LILACS, PUBMED, BDENF, SciELO e CINAHL. A busca dos estudos deu-se entre setembro e novembro de 2019, nos idiomas português, inglês ou espanhol, utilizando os termos dos DeCS e MeSH. A seleção dos artigos foi realizada por três pesquisadores e foram extraídas informações: país, ano de publicação, delineamento do estudo, número de pacientes, intervenções, desfechos e nível de evidência científica. Selecionaram-se 10 artigos processados no software IRAMUTEQ® e analisados descritivamente pelo modelo de Reinert. Resultados: Organizaram-se sete classes: Cuidados com o cateter após a hemodiálise; Cuidados com a FAV antes da hemodiálise; Cuidados com a FAV após a hemodiálise; Cuidados para evitar a interrupção do funcionamento da FAV; Autocuidado dos pacientes com a FAV; Cuidados realizados pela equipe de enfermagem; Conhecimento do paciente acerca dos cuidados com a pele e punção da FAV. Conclusão: Identificou-se que os cuidados com os acessos vasculares mais frequentes se relacionam com a fístula arteriovenosa, demonstrando sua grande representatividade no tratamento do paciente com doença renal crônica. A síntese do conhecimento proporcionada nesta revisão foi utilizada para a elaboração de uma cartilha educativa já validada por especialistas e por pacientes que realizam hemodiálise.
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Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis. Sci Rep 2020; 10:8162. [PMID: 32424319 PMCID: PMC7235247 DOI: 10.1038/s41598-020-64985-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/22/2020] [Indexed: 11/08/2022] Open
Abstract
Despite all efforts, still many end-stage kidney disease (ESKD) patients are dialysed using a central tunnelled catheter (CTC) as vascular access. When the CTC blood flow becomes ineffective, a number of protocols are advised. However, all of them are time- and cost-consuming. The manoeuvre of a non-invasive tunnelled catheter reposition (NTCR) was introduced to restore the CTC function. NTCR was based on gentle movements of the CTC, with or without a simultaneous flushing of the CTC lines, which resulted in a quick reposition of the CTC tip. This study comprises the analysis of a total of 297 NTCRs, which were performed in 114 patients, thus enabling an effective blood flow after 133 procedures (44.7%).Partially effective blood flow followed 123 procedures (41.4%), and it failed altogether in 41 cases (13.9%). Overall, 86% of conducted NTCRs improved the CTC patency to perform a haemodialysis session. The procedure could be successfully repeated, with a similar result after the first and the second attempt. Complications were observed only after 3.4% of all interventions. The novel NTCR manoeuvre was safe and effective in the majority of the CTC dysfunction episodes. It seemed to reduce fibrinolytic usage, allowed an immediate haemodialysis session commencement, therefore, it might save both the costs and the nursing staff time.
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16
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Tseng YH, Liu CY, Lee CP, Lin MH, Yang YH. Effect of carvedilol on arteriovenous graft primary patency. Vascular 2020; 28:765-774. [PMID: 32408854 DOI: 10.1177/1708538120923886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The major mechanisms of arteriovenous graft (AVG) failure due to intimal hyperplasia (IH) are smooth muscle cell proliferation and inflammation. Therefore, carvedilol may improve AVG primary patency because of its anti-proliferative and anti-inflammatory activities. METHODS The data of end-stage renal disease patients receiving regular hemodialysis were collected from the National Health Insurance Research database. The end point was the first percutaneous transluminal angioplasty (PTA) for AVG failure or death during a follow-up period of two years or the end of 2013. The analysis was calculated with Cox proportional hazard model. RESULTS There were 3028 patients treated with carvedilol and 13,704 patients not treated with carvedilol. According to a univariate analysis, the carvedilol group was younger, received more anti-hypertensive medications and platelet aggregation inhibitors, and had higher rates of diabetes mellitus and hyperlipidemia but had lower rates of hypotension and smoking. According to a multivariate analysis, after controlling for covariates, the use of carvedilol for more than 84 days reduced the probability of a first PTA for AVG failure by 9% compared with no use of carvedilol (p = 0.021), but the use of carvedilol for 1 to 84 days did not. CONCLUSION The results of this study indicate that the use of carvedilol for more than 84 days improves the primary patency of AVGs, but the use of carvedilol for less than 84 days does not.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch.,Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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17
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Faponle A, Olatise O, Igbokwe M, Asaolu S. Outcomes of tunneled and nontunneled internal jugular catheters for hemodialysis at Zenith Medical and Kidney centre, Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_77_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Fused Deposition Modelling as a Potential Tool for Antimicrobial Dialysis Catheters Manufacturing: New Trends vs. Conventional Approaches. COATINGS 2019. [DOI: 10.3390/coatings9080515] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rising rate of individuals with chronic kidney disease (CKD) and ineffective treatment methods for catheter-associated infections in dialysis patients has led to the need for a novel approach to the manufacturing of catheters. The current process requires moulding, which is time consuming, and coated catheters used currently increase the risk of bacterial resistance, toxicity, and added expense. Three-dimensional (3D) printing has gained a lot of attention in recent years and offers the opportunity to rapidly manufacture catheters, matched to patients through imaging and at a lower cost. Fused deposition modelling (FDM) in particular allows thermoplastic polymers to be printed into the desired devices from a model made using computer aided design (CAD). Limitations to FDM include the small range of thermoplastic polymers that are compatible with this form of printing and the high degradation temperature required for drugs to be extruded with the polymer. Hot-melt extrusion (HME) allows the potential for antimicrobial drugs to be added to the polymer to create catheters with antimicrobial activity, therefore being able to overcome the issue of increased rates of infection. This review will cover the area of dialysis and catheter-related infections, current manufacturing processes of catheters and methods to prevent infection, limitations of current processes of catheter manufacture, future directions into the manufacture of catheters, and how drugs can be incorporated into the polymers to help prevent infection.
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Adwaney A, Lim C, Blakey S, Duncan N, Ashby DR. Central Venous Stenosis, Access Outcome and Survival in Patients undergoing Maintenance Hemodialysis. Clin J Am Soc Nephrol 2019; 14:378-384. [PMID: 30765534 PMCID: PMC6419278 DOI: 10.2215/cjn.07010618] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Central venous catheters have traditionally provided access for urgent hemodialysis, but are also sometimes advocated as an option for older or more comorbid patients. Adverse effects of this type of dialysis access include central venous stenosis, for which the risk factors and consequences are incompletely understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted two studies within the same population cohort, comprising all patients starting hemodialysis in a single center from January 2006 to December 2013. First, patients were retrospectively analyzed for the presence of central venous stenosis; their access outcomes are described and survival compared with matched controls drawn from the same population. Second, a subset of patients with a history of catheter access within this cohort was analyzed to determine risk factors for central venous stenosis. RESULTS Among 2811 patients, central venous stenosis was diagnosed in 120 (4.3%), at a median dialysis vintage of 2.9 (interquartile range, 1.8-4.6) years. Compared with matched controls, patients with central venous stenosis had similar survival (median 5.1 versus 5.2 years; P=0.54). Among a subset of 500 patients, all with a history of catheter use, 34 (6.8%) developed central venous stenosis, at a rate of 2.2 per 100 patient-years. The incidence of central venous stenosis was higher with larger number of previous catheters (relative risk [RR], 2.2; 95% confidence interval [95% CI]. 1.6 to 2.9), pacemaker insertion (RR, 3.9; 95% CI, 1.7 to 8.9), and was lower with older age (RR, 0.7 per decade; 95% CI, 0.6 to 0.8). In a Cox proportional hazards model, the catheter number, pacemaker, and younger age at dialysis initiation were all significant independent risk factors for central venous stenosis. CONCLUSIONS Central venous stenosis occurred in a minority of patients on hemodialysis, and was associated with compromised future access, but unchanged survival. Among patients with a history of catheter use, risk related to both the number of catheters and the total catheter duration, although nondialysis factors such as pacemakers were also important. Central venous stenosis risk was lower in older patients, supporting the selective use of tunneled catheters in this group.
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Affiliation(s)
- Anamika Adwaney
- West London Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust, London, UK
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20
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Raji YR, Ajayi SO, Aminu O, Abiola B, Efuntoye O, Salako BL, Arije A, Kadiri S. Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria. Pan Afr Med J 2018; 31:218. [PMID: 31447977 PMCID: PMC6691283 DOI: 10.11604/pamj.2018.31.218.17525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/25/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan. Methods a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes. Results a total number of 147 catheters were inserted during the period under review, 94 were males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%. Conclusion internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis.
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Affiliation(s)
- Yemi Raheem Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Samuel Oluwole Ajayi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Olusegun Aminu
- Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Busayo Abiola
- Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Oluwafemi Efuntoye
- Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Babatunde Lawal Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Ayodeji Arije
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Solomon Kadiri
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria
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21
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Yao CL, Tan ZL, Tian R, Miao P, Chen X, Yu ZY. Alternative surgical procedure for treating superior vena cava syndrome in a hemodialysis patient. J Vasc Access 2018; 19:401-403. [PMID: 29592765 DOI: 10.1177/1129729817752873] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The incidence of superior vena cava syndrome has been increasing in hemodialysis patients with the widespread use of dialysis catheters. Although endovascular intervention remains the primary choice for treatment, the long-term patency rate is not optimistic. Occlusive lesions are often encountered that cannot be opened using this intervention. Therefore, we chose to present this case involving a pericardial patch used to reconstruct the superior vena cava in the treatment of catheter-associated chronic superior vena cava occlusion. METHODS Here, we report a case of facial swelling and severe bilateral pleural effusion secondary to superior vena cava occlusion in a 41-year-old woman. An endovascular venous intervention was attempted initially but failed. Finally, we adopted a procedure using the pericardium as a patch to reconstruct the superior vena cava, maintaining most of the original anatomical structure. RESULTS This patient's facial swelling and bilateral pleural effusion disappeared after the operation. In addition, her symptoms of coughing and dyspnea were relieved. The Brescia-Cimino fistula in her left forearm functioned well. CONCLUSION The use of a pericardial patch to reconstruct the superior vena cava is a reliable approach in patients who are not candidates for endovascular treatment.
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Affiliation(s)
- Chen L Yao
- Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng L Tan
- Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ran Tian
- Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Peng Miao
- Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Chen
- Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng Y Yu
- Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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22
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Ghahremani-Ghajar M, Jin A, Borghei P, Chen JLT. An unusual case of an irretrievable hemodialysis catheter in a patient with end stage renal disease. Hemodial Int 2017; 22:E1-E5. [DOI: 10.1111/hdi.12584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mehrdad Ghahremani-Ghajar
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Anna Jin
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Peyman Borghei
- Department of Interventional Radiology; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Joline L. T. Chen
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
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23
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Talreja H, Ryan SE, Graham J, Sood MM, Hadziomerovic A, Clark E, Hiremath S. Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes. PLoS One 2017; 12:e0174061. [PMID: 28346468 PMCID: PMC5367692 DOI: 10.1371/journal.pone.0174061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data. OBJECTIVES 1) To determine factors associated with catheters becoming embedded and 2) to determine outcomes associated with endoluminal dilatation. METHODS All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters. RESULTS We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years) and history of central venous stenosis. CONCLUSION Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis.
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Affiliation(s)
- Hari Talreja
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Edward Ryan
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet Graham
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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24
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Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, Lok C, Luscombe R, Moist L, Oliver M, MacRae J. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis 2016; 3:2054358116669129. [PMID: 28270921 PMCID: PMC5332080 DOI: 10.1177/2054358116669129] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023] Open
Abstract
Catheter-related bloodstream infections, exit-site infections, and tunnel infections are common complications related to hemodialysis central venous catheter use. The various definitions of catheter-related infections are reviewed, and various preventive strategies are discussed. Treatment options, for both empiric and definitive infections, including antibiotic locks and systemic antibiotics, are reviewed.
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Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Jennifer MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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25
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Clark E, Kappel J, MacRae J, Dipchand C, Hiremath S, Kiaii M, Lok C, Moist L, Oliver M, Miller LM. Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters. Can J Kidney Health Dis 2016; 3:2054358116669128. [PMID: 28270920 PMCID: PMC5332079 DOI: 10.1177/2054358116669128] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/20/2022] Open
Abstract
Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance.
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Affiliation(s)
- Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | | | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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26
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MacRae JM, Dipchand C, Oliver M, Moist L, Lok C, Clark E, Hiremath S, Kappel J, Kiaii M, Luscombe R, Miller LM. Arteriovenous Access Failure, Stenosis, and Thrombosis. Can J Kidney Health Dis 2016; 3:2054358116669126. [PMID: 28270918 PMCID: PMC5332078 DOI: 10.1177/2054358116669126] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 01/29/2023] Open
Abstract
Vascular access–related complications can lead to patient morbidity and reduced patient quality of life. Some of the common arteriovenous access complications include failure to mature, stenosis formation, and thrombosis.
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Affiliation(s)
- Jennifer M MacRae
- Cumming School of Medicine and Department of Cardiac Sciences, University of Calgary, Alberta, Canada
| | | | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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27
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MacRae JM, Dipchand C, Oliver M, Moist L, Yilmaz S, Lok C, Leung K, Clark E, Hiremath S, Kappel J, Kiaii M, Luscombe R, Miller LM. Arteriovenous Access: Infection, Neuropathy, and Other Complications. Can J Kidney Health Dis 2016; 3:2054358116669127. [PMID: 28270919 PMCID: PMC5332082 DOI: 10.1177/2054358116669127] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022] Open
Abstract
Complications of vascular access lead to morbidity and may reduce quality of life. In this module, we review both infectious and noninfectious arteriovenous access complications including neuropathy, aneurysm, and high-output access. For the challenging patients who have developed many complications and are now nearing their last vascular access, we highlight some potentially novel approaches.
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Affiliation(s)
- Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Serdar Yilmaz
- Department of Surgery, University of Calgary, Alberta, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Kelvin Leung
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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