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Juneja A, Wang DE, Whitaker L, Hoffstaetter T, Silpe J, Landis GS, Etkin Y. Outcomes of balloon-assisted maturation with large-diameter balloons. J Vasc Access 2024:11297298241266668. [PMID: 39149905 DOI: 10.1177/11297298241266668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
OBJECTIVES Balloon-assisted maturation (BAM) is a well-established technique for maturation of inadequate arteriovenous fistulas (AVF). The objective of this study was to evaluate outcomes of initial BAM using large-diameter angioplasty balloons. METHODS Charts of patients who underwent BAM between 2018 and 2021 at a single academic institution were reviewed. AVF maturation rate was the primary outcome. Secondary outcomes included procedural complications, re-intervention rates, post-procedure vein diameter, and time to catheter-free hemodialysis (HD). Outcomes of patients that underwent initial BAM with ⩾7 mm diameter balloons (Group I) were compared to those of patients that had initial BAM with <7 mm balloons (Group II). RESULTS Group I (n = 149) was a significantly younger cohort and had more men compared to Group II (n = 90). There were no significant differences associated with procedural details and complication rates. Median vein diameter was larger (5.9 mm, IQR: 5-6.4) in Group I compared to Group II (5.1 mm, IQR: 4.2-5.9; p = 0.03) on post-procedure Duplex ultrasound. There was also a higher incidence of vein stenosis in Group II. The overall maturation rate was higher in Group I (97% vs 88%, p = 0.003), and a larger proportion of patients in Group II required more than one BAM to achieve maturation (33% vs 16%, p = 0.002). The median time to catheter-free HD after first BAM was 29 days (IQR: 19-47) in Group I and 42 days (IQR: 24-75) in Group II (p = 0.002). At 60 days after first BAM, the incidence of catheter-free HD was 83% in Group I versus 67% in Group II (p = 0.001). CONCLUSIONS Our study demonstrates that the ability to utilize large angioplasty balloons during initial BAM is associated with higher rates of AVF maturation with fewer re-interventions and shorter time to catheter-free dialysis. AVFs that can tolerate this procedure often have more favorable baseline characteristics.
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Affiliation(s)
| | - David E Wang
- Northwell, New Hyde Park, NY, Department of Surgery at Zucker School of Medicine, Manhasset, NY, USA
| | | | - Tabea Hoffstaetter
- Northwell, New Hyde Park, NY, Department of Surgery at Zucker School of Medicine, Manhasset, NY, USA
| | - Jeffrey Silpe
- Northwell, New Hyde Park, NY, Department of Surgery at Zucker School of Medicine, Manhasset, NY, USA
| | - Gregg S Landis
- Northwell, New Hyde Park, NY, Department of Surgery at Zucker School of Medicine, Manhasset, NY, USA
| | - Yana Etkin
- Northwell, New Hyde Park, NY, Department of Surgery at Zucker School of Medicine, Manhasset, NY, USA
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Ye M, Xiang D, Li L, Qin Y, Zhu Y, He L, Guo C. Guidewire entrapment in the Chiari network during the insertion of a hemodialysis catheter: a case report. BMC Nephrol 2024; 25:242. [PMID: 39075350 PMCID: PMC11287887 DOI: 10.1186/s12882-024-03618-7] [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: 12/25/2023] [Accepted: 05/17/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The Chiari network, a remnant of fetal anatomy, consists of a mesh-like structure within the right atrium. With advancements in cardiac interventions, complications associated with the Chiari network have increasingly been reported. However, there are few reports about guidewire or catheter entrapment in the Chiari network during the insertion of a dialysis catheter. CASE PRESENTATION A 46-year-old male with end-stage renal disease was hospitalized and underwent a digital subtraction angiography-assisted catheterization of the right internal jugular vein tunnel-cuffed dialysis catheter. When the guide wire entered a depth of about 20 cm, it was difficult to advance, manifested as resistance when twisting the guide wire and inability to enter the inferior vena cava. After the peelable sheath was inserted, it was difficult to pull out the guide wire. After repeated attempts to rotate the guide wire, the guide wire was finally pulled out. A fibrous tissue was wrapped around the tip of the guide wire. Its length was 6 cm, with a smooth surface and tough texture. We considered that the tissue we pulled out was most likely a part of a Chiari network. CONCLUSIONS This case highlights the potential for the Chiari network to complicate surgical procedures, including difficulty with guidewire and catheter manipulation. Attention should be paid to Chiari networks. Echocardiography can be used to identify the Chiari network. During the surgery, forcefully pulling out a stuck guidewire is not suggested, to avoid the risk of tearing the atrial wall and causing pericardial tamponade. An urgent consultation with ultrasound doctors and cardiac surgeons might be helpful in such cases.
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Affiliation(s)
- Ming Ye
- Department of Nephrology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongying Xiang
- Department of Ultrasound, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Department of Ultrasound, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yinggang Qin
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Yibing Zhu
- Department of Emergency, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Long He
- Department of Emergency, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Chuan Guo
- Department of Nephrology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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3
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Islam M. Sodium bicarbonate is a potential alternative to classic heparin as a lock solution for non-tunneled dialysis catheters: a result from the prospective randomized BicarbLock trial. Int Urol Nephrol 2024; 56:1465-1474. [PMID: 37823971 DOI: 10.1007/s11255-023-03821-9] [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: 06/21/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Temporary vascular access is mandatory for acute hemodialysis. Heparin lock solution is the standard of care worldwide. Many lock solutions were studied in terms of thrombosis and catheter-related infection prevention, but none replaced heparin as a standard measure. Our main aim is to investigate the effectiveness of sodium bicarbonate (NaHCO3), a ubiquitous and cheap option as a catheter lock solution, in comparison with traditionally used heparin in non-tunneled hemodialysis catheters. METHODS We conducted our prospective study between March 2021 and March 2022. Our study included 441 patients > 18 years old who needed either femoral or jugular non-tunneled dialysis catheters. Patients were assigned to either heparin (5000 IU/ml) or 8.4% sodium bicarbonate on a consecutive basis. Basic characteristics and information regarding catheters, dialysis sessions, and complications were recorded. We divided patients according to the catheter insertion site as well as the lock solution. RESULTS We analyzed 426 patients divided into four groups: jugular heparin (n = 113), jugular bicarbonate (n = 113), femoral heparin (n = 113), and femoral bicarbonate (n = 100). Basal characteristics were similar for all groups. The mean time to last effective dialysis in our institution was 10.7 ± 12.1 days for heparin vs 11.5 ± 10.8 days for the bicarbonate group. 25 (5.9%) patients had some kind of blood flow problems (13 in the heparin and 12 in the bicarbonate group). There was no significant difference in terms of catheter malfunction among groups (p = 0.50). Out of these 25 cases, only 12 (7 in heparin and 5 in the bicarbonate arm) had catheter dysfunction (p = 0.386). Sixty-four patients (28%) with jugular catheters were discharged with patent catheters and continued their dialysis in other facilities. CONCLUSION Sodium bicarbonate is as effective as classic unfractionated heparin in preventing catheter lumen thrombosis with a comparable incidence of catheter-related complications. Furthermore, it is a cost-effective option that can be used confidently, especially when heparin is contraindicated. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04772209 (26.02.2021).
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Affiliation(s)
- Mahmud Islam
- Faculty of Medicine, Division of Nephrology, Sakarya University, Adnan Menderes Cad. Sağlık Sok. No. 1, 54100, Adapazarı, Sakarya, Turkey.
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Hyun A, Condon P, Kleidon T, Xu G, Edwards R, Gibson V, Ullman A. Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study. Eur J Oncol Nurs 2024; 69:102520. [PMID: 38394934 DOI: 10.1016/j.ejon.2024.102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not consistently followed. To explore the decision-making and problem-solving process of occlusion management and identify enablers and barriers to implementing evidence for occlusion management in pediatric cancer care. METHODS A qualitative design with individual semi-structured interviews. Participants were selected by purposeful sampling from a tertiary-referral pediatric facility, and semi-structured interviews were conducted. RESULTS A total of 13 clinicians and 5 parents were interviewed. The thematic analysis revealed four main decision-making/problem-solving themes: 1) clinical reasoning and judgement for central venous access devices occlusion, 2) capability in central venous access devices occlusion management, 3) colleague collaboration in the escalation process and 4) lack of adequate support to manage the occlusion. This study identified positive and negative influences on the problem-solving process, including clinicians' psychological capabilities, social and physical resources, and beliefs about consequences. CONCLUSION This study found that clinicians in pediatric cancer care were able to manage central venous access device occlusions using clinical reasoning and judgment skills, which may conflict with evidence-based practices. The study confirmed the importance of a team approach and prior experience in managing central venous access devices in pediatric oncology settings and identified potential conflicts between clinician decisions based on the patient's current and anticipated conditions and implementation of evidence-based practice. Improving documentation and providing visual aids could benefit clinicians' problem-solving processes.
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Affiliation(s)
- Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia.
| | - Paula Condon
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service District, South Brisbane, QLD. Australia.
| | - Tricia Kleidon
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service District, South Brisbane, QLD. Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.
| | - Grace Xu
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia.
| | - Rachel Edwards
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service District, South Brisbane, QLD. Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service District, South Brisbane, QLD. Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service District, South Brisbane, QLD. Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.
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5
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Ding N, Peng H, Zhao W, Yi Y, Ma Y, Guo Y, Li H, Wu X. Effects of Peripherally inserted Central Catheter (PICC) materials and designs on reduction of PICC-related complications: A systematic review and meta-analysis. Int Wound J 2024; 21:e14468. [PMID: 38050652 PMCID: PMC10898378 DOI: 10.1111/iwj.14468] [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: 09/17/2023] [Accepted: 10/15/2023] [Indexed: 12/06/2023] Open
Abstract
Studies showed that integrating coating or valve into Peripherally Inserted Central (PICC) can prevent related complications. However, data regarding efficiency were controversial. Therefore, a systematic review was needed to analyse the effect of PICC materials and designs on reduction of PICC-related complications. We searched PubMed, Cochrane library, EMbase, grey literature and referent literature from inception to 5 August 2022. Randomized controlled trials (RCTs) and case-control study were included. Two authors extracted data independently, using a predesigned Excel form, and assessed the quality of included RCTs according to the Cochrane Handbook for Systematic Reviews (V5.1.0), case-control study was assessed by the Newcastle-Ottawa Scale. Data were analysed using Review Manager (v5.3.0). A total of 10 RCTs and one case-control study were included. Meta-analysis results showed that PICC designs reduce the incidence of obstruction, and at the critical value of PICC-associated bloodstream infection, but may have no effects on other complications. Based on the literature reviewed, we can only say PICC new materials did not reflect significant reduction on complications, what's more, the result needs more multicentre, large RCTs to support. We suggested clinicians combine descriptive research and cost-effect analysis to select appropriate PICC materials and designs for patients.
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Affiliation(s)
- Nannan Ding
- Department of Catheterization CenterHenan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, People's Hospital of zhengzhou UniversityZhengzhouChina
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
| | - Huizhen Peng
- Department of Catheterization CenterHenan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, People's Hospital of zhengzhou UniversityZhengzhouChina
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
| | - Wenli Zhao
- Department of Catheterization CenterHenan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, People's Hospital of zhengzhou UniversityZhengzhouChina
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
| | - Yinping Yi
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
- Department of CCUHenan Provincial People's HospitalZhengzhouChina
| | - Yufeng Ma
- Department of Catheterization CenterHenan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, People's Hospital of zhengzhou UniversityZhengzhouChina
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
| | - Yaru Guo
- Department of Catheterization CenterHenan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, People's Hospital of zhengzhou UniversityZhengzhouChina
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
| | - Haiyun Li
- Department of Catheterization CenterHenan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, People's Hospital of zhengzhou UniversityZhengzhouChina
- Henan Evidence‐based Nursing Centre: A JBI Affiliated GroupThe University of AdelaideZhengzhouChina
| | - Xue Wu
- School of NursingPeking UniversityBeijingChina
- Evidence‐Based Nursing: A Joanna Briggs Institute Affiliated Group, Health Science CentrePeking UniversityBeijingChina
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6
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Gough KL, Dargaville TR, Ullman AJ, Marsh N, Pelzer ES. Haemostatic discs demonstrate physical efficacy against microbes commonly associated with central-line-associated bloodstream infections. J Hosp Infect 2024; 144:111-117. [PMID: 38159727 DOI: 10.1016/j.jhin.2023.12.006] [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: 10/11/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Vascular access devices form an essential component in the management of acute and chronic medical conditions. Introduction and ongoing management of these devices are linked with bundles of care aimed at reducing associated risks including bleeding and infection. AIM To evaluate the antimicrobial potential of the potassium ferrate haemostatic disc on Gram-positive (Staphylococcus aureus) and Gram-negative (Klebsiella pneumoniae, Pseudomonas aeruginosa) bacteria and on Candida albicans. METHODS The impact of the potassium ferrate disc was compared with the often-used chlorhexidine gluconate (CHG) impregnated disc to evaluate the potential efficacy of the potassium ferrate disc as an alternative to CHG in cases with an increased risk of active bleeding. RESULTS In the presence of anticoagulated blood, we observed an inhibitory effect of the haemostatic disc on microbial growth for microbial strains commonly associated with vascular access device related infections. CONCLUSION Our results indicate that the potassium ferrate disc may provide dual clinical benefits with both haemostatic and antimicrobial action observed during in-vitro testing.
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Affiliation(s)
- K L Gough
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, Australia
| | - T R Dargaville
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - A J Ullman
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Services, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - N Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - E S Pelzer
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, Australia.
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7
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Ho P, Binte Taufiq Chong Ah Hoo NNF, Cheng YX, Meng L, Chai Min Shen D, Teo BW, Ma V, Hargreaves CA. The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis. J Vasc Access 2024; 25:71-81. [PMID: 35543398 DOI: 10.1177/11297298221095769] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD. METHOD Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared. RESULTS In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients (p = 0.08), while the cost of group C is significantly lower (p < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not (p = 0.01, p = 0.02, respectively) during the first year of HD. CONCLUSION With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients' clinical journey and healthcare cost.
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Affiliation(s)
- Pei Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore
| | | | - Yi Xin Cheng
- Department of Statistics and Data Science, Faculty of Science, National University of Singapore, Singapore
| | - Lingyan Meng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Boon Wee Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Valerie Ma
- Division of Nephrology, Department of Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Carol Anne Hargreaves
- Department of Statistics and Data Science, Faculty of Science, National University of Singapore, Singapore
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Wang F, Wang Y, Liu J. Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34924. [PMID: 37773817 PMCID: PMC10545263 DOI: 10.1097/md.0000000000034924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/03/2023] [Indexed: 10/01/2023] Open
Abstract
To explore the risk factors for peripherally inserted central venous catheter (PICC)-related complications in children. This retrospective study analyzed data collected from electronic medical records. A total of 584 patients with indwelling PICC treated between January 2019 and August 2021 were included in this study. According to the occurrence of PICC-related complications, the patients without PICC-related complications were included in the control group (n = 538) and those with PICC-related complications were included the observation group (n = 46). The risk factors for PICC-related complications were analyzed. Of the 584 patients with PICCs, 46 (7.88%) had PICC-related complications. Univariate analysis revealed significant differences in venipuncture (P < .001), oozing of blood from the puncture point (P < .001), indwelling time (P < .001), intravenous nutrient solution (P < .001), and catheter type (P = .003). Complications were used as dependent variables. The independent variables were vein puncture, blood oozing at the puncture point, indwelling time, intravenous nutrient solution, and catheter type. Multivariate logistic regression analysis revealed that the vein puncture (odds ratio [OR] 10.115, 95% confidence interval [CI] 5.034-20.323, P < .001), puncture point blood oozing (OR 9.217, 95% CI 3.860-22.004, P < .001), indwelling time (OR 6.390, 95% CI 3.527-10.972, P = .005), intravenous nutrient solution (OR 2.593, 95% CI 1.675-4.015, P < .001), and catheter type (OR 8.588, 95% CI 2.048-19.095, P = .013) were all risk factors for PICC-related complications in children. Venipuncture, oozing of blood from the puncture point, indwelling time, intravenous nutrient solution, and catheter type are risk factors for PICC-related complications in children. Significant attention should be paid to whether the puncture point is bleeding, the presence or absence of an intravenous nutrient solution, duration of catheterization, type of catheterization, and venipuncture. Additionally, preventive nursing measures should be implemented as soon as possible to reduce the risk of complications related to peripheral PICC.
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Affiliation(s)
- Fang Wang
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Yu Wang
- Department of Nuclear Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Jingzhen Liu
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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Driessen W, van der Meijden W, Wanten G, van Hoek F. Long-term patency rate of the translocated autologous saphenous vein versus prosthetic material in vascular access surgery for haemodialysis and parenteral nutrition. J Vasc Access 2023; 24:972-979. [PMID: 34847751 PMCID: PMC10631275 DOI: 10.1177/11297298211013133] [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: 12/29/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the long-term patency rate of the arteriovenous angioaccess (AVA) with interposition of either autologous or prosthetic material as a last option for vascular access in the upper extremity. METHODS This is a retrospective chart review study of all patients who received an AVA with autologous saphenous vein (SV Group, n = 38) or prosthetic material (PTFE Group, n = 25) as a conduit from the year 1996 to 2020 in the Radboud University Medical Center (Radboudumc). Data were retrospectively extracted from two prospectively updated local databases for vascular access, one for haemodialysis (HD) and one for parenteral nutrition (PN). When required, the medical records of each patient were used. Data were eventually collected anonymously and analysed in SPSS 25. Kaplan-Meier life-tables were used for the statistical analysis. RESULTS Primary patency at 12 and 48 months was 30% and 20% in the SV group and 45% and 14% in the PTFE group. No significant difference was shown in the median primary patency rate (p = 0.715). Secondary patency at 12 and 48 months was 63% and 39% in the SV group and 55% and 19% in the PTFE group. This was considered a significant difference in median secondary patency in favour of the SV with 41.16 ± 17.67 months against 13.77 ± 10.22 months for PTFE (p = 0.032). The incidence of infection was significantly lower in the SV group (p = 0.0002). A Kaplan-Meier curve could not detect a significant difference in secondary patency between the access for haemodialysis and the access for parenteral nutrition. The secondary patency of the SV in parenteral nutrition access, was significantly higher when compared with PTFE (p = 0.004). CONCLUSION The SV can be preferred over PTFE when conduit material is needed for long-term vascular access for HD or PN treatment due to its higher secondary patency and lower infection risk.
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Affiliation(s)
- Wouter Driessen
- Department of Vascular surgery, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Wilbert van der Meijden
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Geert Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Frank van Hoek
- Department of Vascular surgery, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
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Rahimi Z, Abdolvand N, Sepehri MM, Khavanin Zadeh M. The association of vitamin-D level with catheter-related-thrombosis in hemodialysis patients: A data mining model. J Vasc Access 2023; 24:606-613. [PMID: 33719687 DOI: 10.1177/11297298211001157] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aims to investigate the association of different risk factors including vitamin-D level with catheter-related-thrombosis in hemodialysis patients by applying data mining techniques. METHODS This study used the retrospectively approach and was done based on the CRISP-DM framework. The data of 1048 hemodialysis patients of Hasheminejad Kidney Center whose first catheterization was between 2014 and 2019 was used for analysis. In this study, patients with a previous history of deep venous thrombosis, thrombophilic condition, and undergone anticoagulant therapy were excluded. The decision tree J48 in WEKA software was used for modeling. The K-fold cross-validation method was also used to evaluate the classification performance. Finally, the model was evaluated by using Confusion Matrix and F-Measure. RESULTS The approved model was accurate in 70.3% of the predictions, and it demonstrated an association between patients' vitamin-D range and catheter-related-thrombosis. CONCLUSION The results indicated that in hemodialysis patients without the history of cancer or high blood pressure, vitamin-D had a significant impact on catheter related thrombosis.
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Affiliation(s)
- Zhaleh Rahimi
- Department of Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Neda Abdolvand
- Department of Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Group of Information Technology Engineering, Department of Industrial Engineering, Tarbiat Modares University, Tehran, Iran
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Affiliation(s)
- Florence Morriello
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont.
| | - Andrew Brown
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont
| | - John Granton
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont
| | - Mark Bonta
- Temetry Faculty of Medicine (Morriello, Brown, Granton, Bonta), University of Toronto; Divisions of General Internal Medicine (Morriello, Bonta), Vascular and Interventional Radiology (Brown) and Respirology (Granton) University of Toronto, Toronto, Ont.; Division of General Internal Medicine (Morriello), Department of Medicine, Northern Ontario School of Medicine, Sudbury, Ont
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12
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Diaz C, Quintero JA, Zarama V, Bustamante-Cristancho LA. Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement. Open Access Emerg Med 2023; 15:21-28. [PMID: 36660271 PMCID: PMC9843503 DOI: 10.2147/oaem.s384081] [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: 07/28/2022] [Accepted: 12/09/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear. Objective We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications. Methods We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed. Results A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications. Conclusion Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.
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Affiliation(s)
- Carime Diaz
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia
| | - Jaime A Quintero
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia,Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia,Correspondence: Jaime A Quintero, Critical Medicine, Emergency Department, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, 760032, Colombia, Tel +57 3184257759, Email
| | - Virginia Zarama
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia
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13
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Demirci R, Sahtiyancı B, Bakan A, Akyuz O. The predictors of catheter-related bloodstream infections in patients undergoing hemodialysis: A single center experience. J Vasc Access 2023; 24:76-81. [PMID: 34137310 DOI: 10.1177/1129729821998836] [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: 01/18/2023] Open
Abstract
BACKGROUND Here we aimed to investigate the predictors of catheter-related bloodstream infections (CRBSI) in patients with acute kidney injury or chronic kidney disease who required renal replacement therapy through a non-tunneled hemodialysis catheter. METHODS A total of 111 patients who received non-tunneled hemodialysis catheters were retrospectively evaluated. Patients were divided into two groups; those who developed CRBSI and those who did not. Patient's demographic data, laboratory results at admission, information regarding catheter infections, and culture results were obtained from electronic medical records. RESULTS The mean age of the patients was 64 ± 16 years, and 51 of them were male. CRBSI occurred in 14 patients (12.6%). Admission serum albumin level (OR: 0.119, 95% CI: 0.019-0.756, p = 0.024), admission mean platelet volume (OR: 2.207, 95% CI: 1.188-4.100, p = 0.012) and catheter duration (OR: 1.580, 95% CI: 1.210-2.064, p = 0.001) were independent predictors for the CRBSI development. ROC curve analysis demonstrated that a catheter duration of 22 days was predictive for presence of CRBSI (78% sensitivity, 76% specificity, AUC: 0.825, 95% CI: 0.724-0.925, p < 0.001). CONCLUSIONS Prolonged catheter duration, low serum albumin, and high mean platelet volume independently predict the development of CRBSI in patients undergoing hemodialysis for acute kidney injury or chronic kidney disease.
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Affiliation(s)
- Recep Demirci
- Department of Nephrology, University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
| | - Berrak Sahtiyancı
- Department of Nephrology, University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
| | - Ali Bakan
- Department of Nephrology, University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
| | - Okan Akyuz
- Department of Nephrology, Bilecik State Hospital, Bilecik, Turkey
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14
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Saunier J, Khzam A, Yagoubi N. Impact of mechanical stress on flexible tubing used for biomedical applications: Characterization of the damages and impact on the patient's health. J Mech Behav Biomed Mater 2022; 136:105477. [PMID: 36219992 DOI: 10.1016/j.jmbbm.2022.105477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
Flexible tubing is a key part of a lot of medical devices used in hospital, but may be subjected to a lot of various mechanical stresses that can led to the failure or to complications for the patients. The nature and causes of these mechanical stresses were listed for peristaltic pump tubing, infusion set tubing and catheters. Their consequences in term of tubing damages and particular contamination were reported. The impact of the chemical nature of the tubing, of its size and also the impact of various parameters of the clinical acts were reviewed. Last the consequences for the patient's health were discussed.
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Affiliation(s)
- J Saunier
- Matériaux et Santé, Faculté de pharmacie, Université Paris Saclay, France.
| | - A Khzam
- Matériaux et Santé, Faculté de pharmacie, Université Paris Saclay, France
| | - N Yagoubi
- Matériaux et Santé, Faculté de pharmacie, Université Paris Saclay, France
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15
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Mohazzab A, Khavanin Zadeh M, Dehesh P, Abdolvand N, Rahimi Z, Rahmani S. Investigation of risk factors for tunneled hemodialysis catheters dysfunction: competing risk analysis of a tertiary center data. BMC Nephrol 2022; 23:300. [PMID: 36056311 PMCID: PMC9440495 DOI: 10.1186/s12882-022-02927-z] [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: 04/09/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemodialysis tunneled catheters are prone to failure due to infection or thrombosis. Prediction of catheter dysfunction chance and finding the predisposing risk factors might help clinicians to prolong proper catheter function. The multidimensional mechanism of failures following infection or thrombosis needs a multivariable and comprehensive analytic approach. METHODS A longitudinal cross-sectional study was implemented on 1048 patients admitted for the first hemodialysis tunneled catheterization attempt between 2013 and 2019 in Shahid Hasheminejdad hospital, Tehran, Iran. Patients' information was extracted from digital and also paper records. Based on their criteria, single and multiple variable analyses were done separately in patients with catheter dysfunction due to thrombosis and infection. T-test and Chi-square test were performed in quantitative and categorical variables, respectively. Competing risk regression was performed under the assumption of proportionality for infection and thrombosis, and the sub-distributional hazard ratios (SHR) were calculated. All statistical inferences were made with a significance level of 0.05. RESULTS Four hundred sixty-six patients were enrolled in the analysis based on study criteria. Samples' mean (SD) age was 54(15.54), and 322 (69.1%) patients were female. Three hundred sixty-five catheter dysfunction cases were observed due to thrombosis 123(26.4%) and infection 242(52%). The Median (range) time to catheter dysfunction event was 243(36-1131) days. Single variable analysis showed a statistically significant higher proportion of thrombosis in females (OR = 2.66, 95% CI: 1.77-4.00) and younger patients, respectively. Multivariate competing risk regression showed a statistically significant higher risk of thrombosis in females (Sub-distributional hazard (SHR) = 1.81), hypertensive (SHR = 1.82), and more obese patients (BMI SHR = 1.037). A higher risk of infection was calculated in younger (Age SHR = 0.98) and diabetic (SHR = 1.63) patients using the same method. CONCLUSION Female and hypertensive patients are considerably at higher risk of catheter thrombosis, whereas diabetes is the most critical risk factor for infectious catheter dysfunction. Competing risk regression analysis showed a comprehensive result in the assessment of risk factors of catheter dysfunction.
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Affiliation(s)
- Arash Mohazzab
- Epidemiology Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | | | - Paria Dehesh
- Epidemiology Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Abdolvand
- Department of Information Technology Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Zhaleh Rahimi
- Department of Information Technology Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Sahar Rahmani
- Department of Information Technology Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
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16
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Soh NYT, Tan BS, Chan SJM, Patel A, Gogna A, Zhuang KD, Tashi S, Venkatanarasimha N, Tay KH, Chandramohan S. Deeper may not be better: relationship between catheter dysfunction and location of the catheter tip in right-sided tunnelled haemodialysis catheters. Clin Radiol 2022; 77:678-683. [PMID: 35717409 DOI: 10.1016/j.crad.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
AIM To examine the relationship between catheter tip location and catheter dysfunction in the context of tunnelled central venous catheters (CVCs) for haemodialysis. MATERIALS AND METHODS This was a retrospective study of 993 haemodialysis patients who underwent insertion of tunnelled CVCs of step-tip design via the right internal jugular vein (IJV). Based on intra-procedural radiographs, the catheter tip was characterised as being in the superior vena cava (SVC), cavo-atrial junction (CAJ), or deep right atrium (DRA). Patients were tracked for 90 days post-procedure for complications resulting in catheter replacement, and these were compared between cohorts. Statistical analysis was performed with Pearson's chi-square and Fisher's exact tests for categorical variables and two-sample t-test and one-way analysis of variance (ANOVA) for continuous variables. RESULTS Ninety-five patients (9.6%) experienced catheter dysfunction necessitating replacement within 90 days of insertion. Tip location in SVC was associated with lower occurrence of catheter dysfunction (1.9%) as compared with the CAJ (8%) and DRA (11%; p=0.049). Catheter replacement due to other complications (catheter-associated bacteraemia, cuff dislodgement, exit-site infection, external catheter damage) showed no statistically significant relation to location of the CVC tip. CONCLUSION When utilising tunnelled CVCs with a step-tip design inserted via the right IJV, location of the catheter tip in the SVC is associated with reduced occurrence of catheter dysfunction as compared to either the CAJ or DRA.
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Affiliation(s)
- N Y T Soh
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - B S Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - S J M Chan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - A Patel
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - A Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - K D Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - S Tashi
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - N Venkatanarasimha
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - K H Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - S Chandramohan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
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17
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Jahangiri F, Salek M, Nassiri SJ, Samadi F, Koohian Mohammadabadi M. Results of Port-A-Cath Implantation: A Cross-Sectional Study about a Single Tertiary Cancer Center Experience. Med J Islam Repub Iran 2022; 36:64. [PMID: 36128276 PMCID: PMC9448478 DOI: 10.47176/mjiri.36.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/15/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Identifying possible complications accompanying central venous catheterization may improve the results. The current study was conducted to clarify the complication rate among port-a-cath implantation in children referred to Ali-Asghar hospital from 2011 to 2015. This study was designed to determine complication rates among the pediatric population who underwent port-a-cath implantation for chemotherapy. Methods: The current observational study reviewed the medical documents of children who were referred to Ali-Asghar hospital from 2011 to 2015. Factors such as underlying disease, demographic characteristics, complications and their management were considered. We analyzed the results of this study using multivariate logistic regression. Results: A total number of 100 patients met the eligibility criteria. In Thirty-two cases, chemoport catheters were removed due to complication management or termination of adjuvant chemotherapeutic treatment. Fifty-one boys and forty-nine girls enrolled in the study. The mean duration of catheter preservation defined per patient was 693 days ±1 year SD. 14 catheters were removed followed by planned treatment termination, while 18 catheters were complicated due to port dysfunction, infection, skin necrosis, and extravasation, hematoma in order of decreasing. Conclusion: Chemo port utilization is mandatory in pediatric patients with cancers demanding adjuvant treatment. The possible complications would be managed by a variety of protocols. Respecting anti-septic principles by trained personnel will prevent the majority of associated complications.
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Affiliation(s)
- Fariba Jahangiri
- Department of Pediatric Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Dr Fariba Jahangiri,
| | - Mahmoud Salek
- Department of Pediatric Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Javad Nassiri
- Department of Pediatric Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariborz Samadi
- Department of Pediatric Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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18
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Pearse I, Corley A, Larsen EN, Rickard CM, Ware RS, Campbell J, Coyer F, Alexandrou E, O'Brien C, Marsh N. Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial. Trials 2022; 23:390. [PMID: 35549750 PMCID: PMC9097412 DOI: 10.1186/s13063-022-06322-9] [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: 11/18/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. METHODS This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) 'standard' (in accordance with local hospital policy) CVAD dressings (control) or (2) 'standard' dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is 'dressing failure' defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). DISCUSSION This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001012864 . Registered on 2 August 2021.
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Affiliation(s)
- India Pearse
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia. .,Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Australia. .,School of Nursing and Midwifery, Griffith University, Brisbane, Australia. .,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.
| | - Amanda Corley
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Herston, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jill Campbell
- National Health and Medical Research Council Centre for Research Excellence, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Fiona Coyer
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia.,Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- AVATAR Group, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery and Centre for Applied Nursing Research, Western Sydney University, Penrith, Australia.,Department of Intensive Care, Liverpool Hospital, Liverpool, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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19
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Maguire IC, Browne LD, Dawood M, Leahy F, Ryan MC, White E, O’Sullivan A, O’Sullivan L, Stack AG. Differential Impact of Central Venous Catheters versus Arteriovenous Fistulae on Quality of Life among Irish Haemodialysis Patients. KIDNEY360 2022; 3:1065-1072. [PMID: 35845328 PMCID: PMC9255886 DOI: 10.34067/kid.0006622021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/01/2022] [Indexed: 01/10/2023]
Abstract
Background Arteriovenous fistulae (AVF) have superior clinical outcomes compared with central venous catheters (CVC) among patients undergoing hemodialysis (HD). Yet, there is increasing recognition that health-related quality of life (HRQoL) may be more important to patients than survival and that differences may exist between AVF and CVCs in this regard. This study compared HRQoL between AVF and CVC in an Irish cohort. Methods We conducted a cross-sectional survey among prevalent patients undergoing hemodialysis (N=119) dialyzing with either an AVF or CVC at a regional program. The Short Form 36 (SF-36) and a validated Vascular Access Questionnaire (SF-VAQ) compared QoL between AVF and CVC in domains of physical functioning, social functioning, and dialysis complications. Multivariable logistic regression compared differences between groups for outcomes of physical functioning, social functioning, and dialysis complications expressed as adjusted odds ratios and 95% CI. Results Mean age was 66.6 years; 52% were using an AVF and 48% had a CVC. Patients dialyzing with an AVF were more satisfied with their access when asked directly (6.2 versus 5.0; P<0.01). Physical functioning scores for bleeding, swelling, and bruising were significantly higher for AVF than CVC (P=0.001, P=0.001, and P<0.001, respectively). In contrast, patients with a CVC reported greater difficulties in bathing and showering than those using an AVF (4.4 versus 2.0; P<0.001), whereas patients with an AVF expressed greater concerns with physical appearances. Compared with AVF, CVC users were less likely to report difficulties in physical functioning (OR=0.35; 95% CI, 0.12 to 0.94; P=0.04) but more likely to report dialysis complications (OR=1.94; 95% CI, 0.69 to 5.87; P=0.22). Conclusions Vascular access contributes to HRQoL in hemodialysis. CVCs are associated with fewer difficulties from bleeding and bruising but greater negative effect on social activities, including bathing and showering. Overall, patients with a CVC had lower dissatisfaction scores than patients with an AVF when all three domains were added. Innovation in vascular access design and engineering may confer benefits and improve patient comfort on HD.
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Affiliation(s)
| | - Leonard D. Browne
- School of Medicine, University of Limerick, Limerick, Ireland,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Mina Dawood
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - Fiona Leahy
- Clinical Research Support Unit, University of Limerick, Limerick, Ireland
| | - Maria C Ryan
- Clinical Research Support Unit, University of Limerick, Limerick, Ireland
| | - Eoin White
- Health Research Institute, University of Limerick, Limerick, Ireland,School of Design, University of Limerick, Limerick, Ireland
| | - Aidan O’Sullivan
- Health Research Institute, University of Limerick, Limerick, Ireland,School of Design, University of Limerick, Limerick, Ireland,Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Center, University of Limerick, Limerick, Ireland
| | - Leonard O’Sullivan
- Health Research Institute, University of Limerick, Limerick, Ireland,School of Design, University of Limerick, Limerick, Ireland,Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Center, University of Limerick, Limerick, Ireland
| | - Austin G. Stack
- School of Medicine, University of Limerick, Limerick, Ireland,Health Research Institute, University of Limerick, Limerick, Ireland,Department of Nephrology, University Hospital Limerick, Limerick, Ireland
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20
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Marin A, Bull L, Kinzie M, Andresen M. Central catheter-associated deep vein thrombosis in cancer: clinical course, prophylaxis, treatment. BMJ Support Palliat Care 2021; 11:371-380. [PMID: 34413028 PMCID: PMC8606430 DOI: 10.1136/bmjspcare-2019-002106] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
The adequate handling of central venous catheters is a key element in the management of patients with cancer. Catheter-associated deep vein thrombosis is frequently observed in patients with malignant diseases; however, despite being a common complication among these patients, objective information concerning its epidemiology, clinical course, prophylaxis and treatment strategies is very limited. The reported incidence of catheter-related thrombosis (CRT) is highly variable, depending on symptomatic events, or if patients are screened for asymptomatic thrombosis. Several factors have been identified as potential predisposing factors for CRT, both technical and pathological aspects. The anticoagulant of choice is still unclear; while low-molecular-weight heparin is most commonly used, recent studies assessing the role of direct oral anticoagulants in the treatment of CRT show promise as an alternative, but the evidence remains insufficient and the decision must be made on a case-by-case basis.
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Affiliation(s)
- Arnaldo Marin
- Department of Basic and Clinical Oncology, University of Chile Faculty of Medicine, Santiago, 8380453, Chile
| | - Leonardo Bull
- School of Medicine, University of Chile, Santiago, 8380453, Chile
| | - Matthew Kinzie
- Neurosciences, University of Texas Health, Houston, Texas, USA
| | - Max Andresen
- Intensive Care Department, Facultad de Medicina . Pontificia Universidad Catolica de Chile, Santiago, 8330077, Chile
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21
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Kakaei F, Mirabolfathi S, Yavari N, Ardalan MR, Mozafar M, Zarrintan S. Hereditary thrombophilia and thrombosis of tunneled hemodialysis catheters: A single center study. J Cardiovasc Thorac Res 2021; 13:79-83. [PMID: 33815706 PMCID: PMC8007903 DOI: 10.34172/jcvtr.2021.06] [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: 10/21/2019] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Vascular access thrombosis increases the risk of mortality and morbidity in end-stage renal disease (ESRD) patients on hemodialysis (HD). This study aimed to evaluate hereditary thrombophilia factors in HD patients and its association with tunneled cuffed catheters’ thrombosis.
Methods: In this cross-sectional study, 60 consecutive patients with ESRD on HD with tunneled cuffed catheters were selected. Inherited thrombophilia factors (Anti-thrombin III, Protein C, Protein S, and Factor V Leiden) were measured and the patients were followed for 3 months to evaluate the incidence of catheter-related thrombosis. The association between these factors and catheter thrombosis was assessed.
Results: The mean age of patients was 60.30 ± 8.69 years. Forty-seven patients (78.30%) were female and thirteen patients (21.70%) were male. The most common cause of ESRD was diabetes mellitus (41.67%). The most catheter site was the right internal jugular vein (55%). There were 22 (36.67%) and 8 (13.33%) cases of thrombosis and mortality, respectively. The association between hereditary thrombophilia factors and catheter thrombosis was not statistically significant (P > 0.05).
Conclusion: In this small group of our patients, the frequency of hereditary thrombophilia was not significantly different between those with and without thrombosis of tunneled HD catheter.
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Affiliation(s)
- Farzad Kakaei
- Department of General Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.,Section of Organ Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Mirabolfathi
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negin Yavari
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ardalan
- Division of Nephrology, Department of Internal Medicine, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Mozafar
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Zarrintan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Koyuncu S, Herdem N, Uysal C, Kahriman G, Kocyigit I, Sipahioğlu M, Tokgoz B, Oymak O. A rare complication following internal jugular vein catheterization to malposition: acute Budd Chiari syndrome. BMC Nephrol 2020; 21:525. [PMID: 33272229 PMCID: PMC7713328 DOI: 10.1186/s12882-020-02182-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/23/2020] [Indexed: 08/30/2023] Open
Abstract
Background Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition. Case presentation After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient’s general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization. Conclusion Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications.
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Affiliation(s)
- Sumeyra Koyuncu
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey.
| | - Nevzat Herdem
- Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Cihan Uysal
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Guven Kahriman
- Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ismail Kocyigit
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murat Sipahioğlu
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bulent Tokgoz
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Oktay Oymak
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
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Moisoglou I, Yfantis A, Tsiouma E, Galanis P. The work environment of haemodialysis nurses and its mediating role in burnout. J Ren Care 2020; 47:133-140. [PMID: 33111493 DOI: 10.1111/jorc.12353] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/29/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The work environment can contribute to the occurrence of nurses' burnout. OBJECTIVES This study assessed the work environment of haemodialysis nurses and the extent of burnout they have suffered, and it explored the connection between work environment and burnout. DESIGN A multicentre cross-sectional study was conducted in 53 public, hospital-based haemodialysis units in Greece. PARTICIPANTS A total of 537 haemodialysis nurses participated. The majority consisted of females (90.8%) who possessed a university degree or a degree from a technological institute (72.6%). They had an average of 15 years of experience in dialysis. MEASUREMENTS The Practice Environment Scale of the Nursing Work Index and the Copenhagen Burnout Inventory (CBI) were used. The demographic characteristics of the participants were also collected. RESULTS Although the nurses rated their work environment as healthy, they were experiencing a moderate degree of burnout. The multivariate linear regression analysis with the CBI scales as dependent variables was applied. The increased nurses' participation in hospital affairs was associated with decreased personal (coefficient β = -9.4, 95% confidence interval [CI] = -17.4 to -1.3, p = 0.023), work-related (coefficient β = -12.9, 95% CI = -22.5 to -3.5, p = 0.008) and patient-related burnout (coefficient β = -15.9, 95% CI = -24.5 to -7.4, p = < 0.001). The better collegial nurse-physician relationships were associated with decreased personal (coefficient β = -10.7, 95% CI = -18.3 to -3.0, p = .007) and work-related burnout (coefficient β = -15.1, 95% CI = -23.3 to -7.0, p = < 0.001). CONCLUSIONS The work environment of haemodialysis nurses was associated with burnout. Its improvement is an important tool in administrations' effort to ensure the nursing staff's well-being.
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Affiliation(s)
- Ioannis Moisoglou
- Quality Assurance and Continuing Education Unit, General Hospital of Lamia, Lamia, Greece
| | - Aris Yfantis
- Quality Assurance and Continuing Education Unit, General Hospital of Lamia, Lamia, Greece
| | - Erasmia Tsiouma
- Haemodialysis Unit, General Hospital of Lamia, Lamia, Greece
| | - Petros Galanis
- Centre for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Gavin NC, Kleidon TM, Larsen E, O'Brien C, Ullman A, Northfield S, Mihala G, Runnegar N, Marsh N, Rickard CM. A comparison of hydrophobic polyurethane and polyurethane peripherally inserted central catheter: results from a feasibility randomized controlled trial. Trials 2020; 21:787. [PMID: 32928286 PMCID: PMC7489010 DOI: 10.1186/s13063-020-04699-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the feasibility of an efficacy trial comparing a hydrophobic polyurethane peripherally inserted central catheter (PICC) with a standard polyurethane PICC. Methods This pilot randomised controlled trial (RCT) was conducted between May 2017 and February 2018. Adult participants (n = 111) were assigned to hydrophobic polyurethane PICC with proximal valve (intervention) or a polyurethane PICC with external clamp (standard care). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were central line-associated bloodstream infection, local infection, occlusion, thrombosis, fracture and dislodgement, phlebitis, local or systemic allergic reaction, and PICC dwell time. Results All feasibility outcomes were achieved, apart from eligibility criteria. In total, 338 patients were screened, 138 were eligible (41%), and of these 111 were randomised (80%). Patients received the allocated PICC in 106 (95%) insertions. No patients withdrew from the study and there was no missing data. PICC failure was 24% (13/55) in the intervention group and 22% (12/55) in the standard care group (p = 0.820). PICC failure per 1000 PICC days was 16.3 in the intervention group and 18.4 in the control group (p = 0.755). The average dwell time was 12 days in the intervention and 8 days in the control group. Conclusions This study demonstrates the feasibility of an efficacy trial of PICC materials in an adult population, once adjustments were made to include not only in-patients, but also patients being discharged to the Hospital in the Home service. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12616001578493. Prospectively registered on 16 November 2016. The trial protocol was published a priori (Kleidon et al., Vasc Access 3:15–21, 2017).
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Affiliation(s)
- Nicole C Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia. .,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia. .,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia. .,Institute of Health and Biomendical Institute to Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Sarah Northfield
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, 4222, Australia.,Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, 4102, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
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25
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Perondi F, Petrescu VF, Fratini F, Brovida C, Porciello F, Ceccherini G, Lippi I. Bacterial colonization of non-permanent central venous catheters in hemodialysis dogs. Heliyon 2020; 6:e03224. [PMID: 32021926 PMCID: PMC6994843 DOI: 10.1016/j.heliyon.2020.e03224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
Non-permanent central venous catheters (CVCs), are the most commonly used vascular access in veterinary patients undergoing hemodialysis. In human dialysis patients, CVC infection represents a common cause of morbidity and mortality. The aim of this retrospective observational study was to evaluate the prevalence of bacterial colonization of CVCs in dogs submitted to hemodialysis treatment at time of CVC removal. The CVCs of all dogs submitted to hemodialysis (n = 23) at the Veterinary Teaching Hospital ''Mario Modenato'' of the University of Pisa between January 2015 and December 2016 were considered. For all dogs, data regarding signalment, reason for hemodialysis treatment, duration of catheterization (≤15 or >15 days), CVC complications, and 30-day survival were considered. Statistical analysis was performed using Graph Pad Prism™. Five over 23 dogs (22%) showed positive bacterial culture of CVC (+), and 18/23 dogs (78%) negative culture of CVC (-). The most prevalent microorganism was Staphylococcus Spp (3/5; 60%). No significant difference was found in the prevalence of CVC infection according to age, gender, reason for hemodialysis, CVC complications, duration of catheterization, and outcome. No statistically significant difference (p = 0.64) in survival curves was reported at log rank analysis between dogs with CVC - and CVC +. The prevalence of bacterial CVC contamination in our dialysis dogs showed relatively low. Exclusive use of CVC for hemodialysis, good hygiene practice during CVC management, and use of chlorhexidine as an antiseptic should be strongly encouraged.
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Affiliation(s)
- Francesca Perondi
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
- Corresponding author.
| | - Vasilica-Flory Petrescu
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | - Filippo Fratini
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| | - Claudio Brovida
- ANUBI Ospedale per Animali da Compagnia, Strada Genova 299/A, 10024, Monalieri, Italy
| | - Francesco Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | - Gianila Ceccherini
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| | - Ilaria Lippi
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
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Superior Vena Cava Endocarditis in a Patient with Anterior Chest Wall Tunneled Catheter for Hemodialysis. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:321-324. [PMID: 32671195 PMCID: PMC7363054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Healthcare related bacterial endocarditis represents a significant portion of endocarditis seen today. Suspicion for these infections should be particularly high in patients with chronic indwelling central venous catheters, and most notably, in patients with hemodialysis catheters. These infections may have a predilection for the superior vena cava due to proximity of the catheters to the great veins of the neck. Transthoracic echocardiography and/or trans-esophageal echocardiography should be done promptly in patients in which there a high suspicion for such infections, in order to identify these lesions, and guide appropriate management with either antibiotics or surgical intervention. CASE PRESENTATION We present a 59-year-old female with multiple comorbidities including diabetes mellitus and end-stage renal disease requiring dialysis via an anterior chest wall catheter, who presented with fever, chills, and abdominal pain. She was found to have pus in and around her catheter. Further evaluation with trans-esophageal echocardiography revealed the presence of a superior vena cava vegetation extending into the right atrium. She received a 6 week course of appropriate antibiotics with repeat trans-esophageal echocardiography showing a significant reduction in the size of the vegetation. Patient remained afebrile, and without leukocytosis and negative blood cultures for the remainder of her hospital stay.
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27
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Fox J, Joubert G, Loggenberg E. Tunnelled haemodialysis catheters in central Free State: Epidemiology and complications. SA J Radiol 2019; 23:1791. [PMID: 31824740 PMCID: PMC6890547 DOI: 10.4102/sajr.v23i1.1791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/03/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is a disease with profound impact on the patient, health system and economy. Tunnelled haemodialysis catheters (TDC) are amongst the most common dialysis methods. It has been established internationally that certain demographic descriptors and aetiologies carry an increased risk of complications. There is a dearth of epidemiological profiling of ESRD patients with TDC in South Africa. OBJECTIVE To establish the epidemiological profile of patients who received TDC and to establish the complication rate, with the goal of demonstrating associations between the epidemiological profiles and complications. METHOD This was a retrospective study of all patients who received TDC in an Academic Hospital Interventional Radiological Suite over a period of 60 months between 01 March 2011 and 29 February 2016. RESULTS A total of 179 patients received 231 catheters. The majority of patients were male (58.7%) and 35.8% of the patients resided in Mangaung. The leading aetiologies of ESRD included hypertensive nephropathy (43.6%), primary glomerular disease (17.3%) and HIV-associated nephropathy (6.1%). Procedural complications occurred in 7/224 (3.1%) insertions, whilst 37/185 (20.0%) developed catheter-related infection and 54/185 (29.2%) developed dysfunctional catheters. There were no deaths linked to catheter-related complications. CONCLUSION Our patients' demographic profile, ESRD aetiology, complication rate for procedural complications and catheter-related infections are roughly on par with international studies; however, the catheter dysfunction rate is higher than in the aforementioned studies. This possibly reflects the difficulty of accessing specialist care for our patients, the majority of whom reside outside the Mangaung district. Further studies with larger sample sizes are required to demonstrate statistically relevant associations.
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Affiliation(s)
- John Fox
- Department of Radiology, Universitas Academic Hospital complex, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
| | - Eugene Loggenberg
- Department of Radiology, Universitas Academic Hospital complex, University of the Free State, Bloemfontein, South Africa
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28
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Wongmahisorn Y. Maturation of arteriovenous fistulas in patients with and without preexisting hemodialysis catheters. Ann Med Surg (Lond) 2019; 48:11-16. [PMID: 31693714 PMCID: PMC6806382 DOI: 10.1016/j.amsu.2019.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 12/13/2022] Open
Abstract
Background Central venous catheter (CVC) placement has been linked to systemic inflammation. This study was conducted to compare the successful maturation of arteriovenous fistulas (AVFs) and the preoperative white blood cell (WBC) profiles between patients with and without preexisting CVCs. Materials and methods A retrospective cohort study was conducted with 550 patients who underwent first-time AVF creation. Patients were divided into three groups according to preexisting CVCs and CVC types as follows: tunneled CVC (n = 23), nontunneled CVC (n = 223), and no CVC (n = 304). These three groups were compared in terms of AVF maturation and preoperative WBC profiles. Results The mean age of the patients was 61.1 ± 14.3 years. The AVF maturation rates of the tunneled CVC, nontunneled CVC and no CVC groups were 65.2%, 54.7% and 74.7%, respectively (p < 0.001). According to the uni- and multivariate analyses, only the nontunneled CVC group had a lower odds of AVF maturation compared to the no CVC group (adjusted odds ratio 0.43; 95% confidence interval 0.29–0.62). Patients with preexisting nontunneled CVC but not tunneled CVC also had significantly higher mean WBC and neutrophil counts but a lower percentage of lymphocytes than patients with no preexisting CVC. Conclusion Preexisting nontunneled CVC had a negative impact on the successful maturation of the newly created AVF. Patients in the nontunneled CVC group had the highest preoperative WBC and neutrophil counts but the lowest lymphocyte percentage compared to patients in the other two groups. Nontunneled CVC has a negative impact on the successful maturation of AVF. AVF maturation could be affected by duration of CVC placement. Preexisting nontunneled CVC is significantly related to high preoperative WBC count.
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Affiliation(s)
- Yuthapong Wongmahisorn
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
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29
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El-Hennawy AS, Frolova E, Romney WA. Sodium bicarbonate catheter lock solution reduces hemodialysis catheter loss due to catheter-related thrombosis and blood stream infection: an open-label clinical trial. Nephrol Dial Transplant 2019; 34:1739-1745. [PMID: 30668833 PMCID: PMC6775472 DOI: 10.1093/ndt/gfy388] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is no ideal lock solution that prevents hemodialysis (HD) catheter loss due to catheter-related thrombosis (CRT) and catheter-related bloodstream infection (CRBSI). Catheter loss is associated with increased hospitalization and high inpatient costs. Sodium bicarbonate (NaHCO3) demonstrates anti-infective and anticoagulation properties with a good safety profile, making it an ideal lock solution development target.The objective of this study was to determine the safety and efficacy of using sodium bicarbonate catheter lock solution (SBCLS) as a means of preventing HD catheter loss due to CRT and CRBSI. METHODS The study took place in a community hospital in Brooklyn, NY, USA. All admitted patients ≥18 years of age who needed HD treatment through CVC were included in the study. 451 patients included in the study were provided SBCLS or NSCLS post-dialysis. Catheter loss due to CRT or CRBSI was evaluated over a period of 546 days. RESULTS A total of 452 patients met the criteria; 1 outlier was excluded, 226 were in the NSCLS group and 225 were in the SBCLS group. There were no significant differences between groups in comorbidities at the outset. The NSCLS group had CRT and CRBSI rates of 4.1 and 2.6/1000 catheter days (CD), respectively, compared with 0.17/1000 CD for both outcomes in the SBCLS group. SBCLS patients had a significantly reduced catheter loss rate due to CRT (P < 0.0001) and CRBSI (P = 0.0004). NSCLS patients had higher odds of losing their catheter due to CRT {odds ratio [OR] 26.6 [95% confidence interval (CI) 3.57-198.52]} and CRBSI [OR 15.9 (95% CI 2.09-121.61)] during the study period. CONCLUSION The novel approach of using SBCLS was found to be safe and was statistically superior to normal saline in preventing HD catheter loss due to CRT and CRBSI. NaHCO3 solution is inexpensive, readily available in various settings and holds the potential to decrease hospitalization, length of stay and dialysis-related costs. TRIAL REGISTRATION Maimonides Medical Center Investigational Review Board, Study IRB 2015-06-25-CIH. ClinicalTrials.gov identifier: NCT03627884.
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Affiliation(s)
- Adel S El-Hennawy
- Department of Nephrology, NYC Health + Hospitals/Coney Island, Brooklyn, NY, USA
| | - Elena Frolova
- Department of Nephrology, NYC Health + Hospitals/Coney Island, Brooklyn, NY, USA
| | - Wesley A Romney
- Department of Medicine, NYC Health + Hospitals/Coney Island, Brooklyn, NY, USA
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Molnar AO, Bota SE, McArthur E, Lam NN, Garg AX, Wald R, Zimmerman D, Sood MM. Risk and complications of venous thromboembolism in dialysis patients. Nephrol Dial Transplant 2019; 33:874-880. [PMID: 28992258 DOI: 10.1093/ndt/gfx212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
Abstract
Background Contemporary data on venous thromboembolism (VTE) risk in dialysis patients are limited. Our objective was to determine the risk and complications of VTE among incident maintenance dialysis patients. Methods We performed a retrospective cohort study using administrative databases. We included adult incident dialysis patients from 2004 to 2010 (n = 13 315). Dialysis patients were age- and sex-matched to individuals of the general population using a 1:4 ratio (n = 53 260). We determined the 3-year cumulative incidence and incidence rate (IR) of VTE, pulmonary embolism (PE) and deep venous thrombosis (DVT). We examined outcomes of bleeding and all-cause mortality following a VTE event among matched dialysis patients who did and did not experience a VTE. We used Cox proportional hazards regression models, stratified on matched sets, to calculate the hazard ratios (HRs) for all outcomes of interest. Results VTE occurred in 1114 (8.4%) dialysis patients compared with 1233 (2.3%) individuals in the general population {IR 37.1 versus 8.1 per 1000 person-years; HR 4.5 [95% confidence interval (CI) 4.1-4.9]; adjusted HR 2.9 (95% CI 2.6-3.4)}. Both components of VTE [PE and DVT; adjusted HR 4.0 (95% CI 2.9-5.6) and HR 2.8 (95% CI 2.4-3.2), respectively] occurred more frequently in dialysis patients. Compared with dialysis patients without a VTE, those with a VTE had a higher risk of bleeding [adjusted HR 2.0 (95% CI 1.3-2.9)] and all-cause mortality [adjusted HR 2.4 (95% CI 2.0-2.8)]. Conclusions VTE is common in dialysis patients and confers a high risk of major bleeding and all-cause mortality. Thromboprophylaxis and VTE treatment studies in dialysis patients are needed.
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Affiliation(s)
- Amber O Molnar
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.,Department of Medicine, Division of Nephrology, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sarah E Bota
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
| | - Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.,Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada
| | - Ron Wald
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.,Department of Medicine, Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Deborah Zimmerman
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.,Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings. Crit Care Med 2019; 46:1998-2009. [PMID: 30095499 DOI: 10.1097/ccm.0000000000003370] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To examine the proportion and rate of central venous access device failure and complications across central venous access device types in adult intensive care. DATA SOURCES A systematic search was undertaken in the electronic databases Cochrane Central Register of Controlled Trials, Embase, U.S. National Library of Medicine National Institutes of Health, and Cumulative Index to Nursing and Allied Health in September 2017. STUDY SELECTION Included studies were of observational (prospective and retrospective) or interventional design and reported central venous access device failure and complications in adult ICU settings. Studies were excluded if they were published prior to November 2006 or not reported in English. Two reviewers independently screened articles, assessed eligibility, extracted data, and assessed risk of bias. DATA EXTRACTION Data were extracted on the primary outcome, central venous access device failure, and secondary outcomes: central venous access device complications (central line-associated bloodstream infection, catheter-related bloodstream infection, catheter-related thrombosis, occlusion, catheter removal due to suspected infection, dislodgement, breakage, and local infection). Patient and device data and study details to assess the study quality were also extracted. DATA SYNTHESIS A total of 63 studies involving 50,000 central venous access devices (396,951 catheter days) were included. Central venous access device failure was 5% (95% CI, 3-6%), with the highest rates and proportion of failure in hemodialysis catheters. Overall central line-associated bloodstream infection rate was 4.59 per 1,000 catheter days (95% CI, 2.31-6.86), with the highest rate in nontunneled central venous access devices. Removal of central venous access device due to suspected infection was high (17%; 20.4 per 1,000 catheter days; 95% CI, 15.7-25.2). CONCLUSIONS Central venous access device complications and device failure is a prevalent and significant problem in the adult ICU, leading to substantial patient harm and increased healthcare costs. The high proportion of central venous access devices removed due to suspicion of infection, despite low overall central line-associated bloodstream infection and catheter-related bloodstream infection rates, indicates a need for robust practice guidelines to inform decision-making surrounding removal of central venous access devices suspected of infection.
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Kumwenda M, Dougherty L, Spooner H, Jackson V, Mitra S, Inston N. Managing dysfunctional central venous access devices: a practical approach to urokinase thrombolysis. ACTA ACUST UNITED AC 2019; 27:S4-S10. [PMID: 29368572 DOI: 10.12968/bjon.2018.27.2.s4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tunnelled central venous access devices (CVADs) are defined as any intravenous multipurpose catheters placed within the central veins for use in haemodialysis and administration of blood products or chemotherapy in oncology and haematological conditions. Frequent complications include thrombosis and catheter-related infection, which may lead to significant adverse patient outcomes. Once thrombosis is suspected correction should be attempted empirically with thrombolytic agents. Commonly available thrombolytic agents in the UK include urokinase (Syner-Kinase) and alteplase (Cathflo). It is well recognised that urokinase usage differs widely and concerns were raised by clinicians about the variation of dose regimens nationally. The objective of the CVAD Focus Group was to address this issue and offer guidance in the management of suspected thrombosis of CVAD with urokinase using two algorithms for renal and non-renal dysfunctional CVAD and to audit prospectively the outcomes of intervention.
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Affiliation(s)
| | - Lisa Dougherty
- Formerly IV Consultant Nurse, The Royal Marsden Hospital, Sutton
| | - Helen Spooner
- Advanced Nurse Practitioner, Renal Unit, New Cross Hospital, Wolverhampton
| | - Victoria Jackson
- Haemodialysis Sister, Renal Unit, Manchester Royal Infirmary, Manchester
| | - Sandip Mitra
- Consultant Nephrologist, Manchester Royal Infirmary, Manchester
| | - Nicholas Inston
- Consultant in Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham
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Recognition and management of dermatologic complications from interventional radiology procedures. Diagn Interv Imaging 2019; 100:659-670. [PMID: 31302074 DOI: 10.1016/j.diii.2019.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023]
Abstract
A variety of dermatologic complications can occur after interventional radiology procedures, including fluoroscopy-induced radiation dermatitis, thermal skin injury from tumor ablation, non-target embolization to the skin, allergic reactions related to interventional radiology procedures, and dermatitis and infections at catheter sites. Yet, interventional radiologists typically lack training in dermatology. This review focuses on recognition of dermatologic complications and introduces basic principles for management of these complications. By taking a more active role in the diagnosis, management, and follow-up of dermatologic complications, interventional radiologists can improve the care for patients suffering iatrogenic skin inury.
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Mira FS, Cabral JP, Rodrigues L, Oliveira N, Agostinho G, Galvão A, Alves R. Multiple complications of a 14-year-old hemodialysis catheter. J Vasc Access 2019; 20:567-569. [PMID: 31190613 DOI: 10.1177/1129729819854828] [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
INTRODUCTION Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. CASE REPORT We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. DISCUSSION This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.
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Affiliation(s)
- Filipe Santos Mira
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - João Pina Cabral
- 3 Internal Medicine Department, Coimbra University Hospital, Coimbra, Portugal
| | - Luís Rodrigues
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Nuno Oliveira
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gil Agostinho
- 4 Interventional Radiology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Ana Galvão
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Rui Alves
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
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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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Mohamed H, Ali A, Browne LD, O'Connell NH, Casserly L, Stack AG, Hussein WF. Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study. BMC Nephrol 2019; 20:68. [PMID: 30808313 PMCID: PMC6390569 DOI: 10.1186/s12882-019-1253-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. Methods A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. Results The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10–24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62–2.97) versus 0.11 (0.01–0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92–83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69–9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. Conclusions Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance. Electronic supplementary material The online version of this article (10.1186/s12882-019-1253-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Husham Mohamed
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Alaa Ali
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard D Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Division of Microbiology, Department of Medicine, University Hospital Limerick, Limerick, Ireland
| | - Liam Casserly
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Austin G Stack
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Wael F Hussein
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Beck O, Muensterer O, Hofmann S, Rossmann H, Poplawski A, Faber J, Gödeke J. Central Venous Access Devices (CVAD) in Pediatric Oncology Patients-A Single-Center Retrospective Study Over More Than 9 Years. Front Pediatr 2019; 7:260. [PMID: 31294007 PMCID: PMC6603206 DOI: 10.3389/fped.2019.00260] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/07/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Central venous access devices (CVAD) provide important benefits in the management of oncological pediatric patients. However, these catheters are responsible for severe complications. Methods: In this context, we aimed to analyze all patients receiving a CVAD in the Department of Pediatric Hematology and Oncology of the University hospital of Mainz over a period of 9 years, focused on CVAD related complications. Data on demographics, as well as intraoperative and postoperative complications were extracted. Results: A total of 296 patients with a mean age 93.2 ± 62.4 months were analyzed. The majority suffered from leukemia (n = 91, 30.7%), lymphomas (n = 50, 16.9%), and brain tumors (n = 48, 16.2%). In 63 (21.3) patients, complications were observed. No death caused by complications of CVADs was found in our series. Catheter-related blood stream infections (BSI) (7.4%) were most prevalent, followed by dislodgements (5.4%), occlusions (2.7%), thrombosis (2.4%), and catheter leakage (2.4%). Insertion site infections were observed in three patients (1.0%). Fifty-nine percent of all patients with catheter-related BSI suffered from Leukemia. In patients with Catheter-related BSIs we detected the condition leukemia as the underlying disease as a risk factor compared to solid tumors as the underlying disease. Overall, totally implanted devices (ports) have a lower complication rate than tunneled catheter. Conclusion: Implantation of CVADs seems to be safe and reliable in this large pediatric patient cohort. Even if complications occur in the long-term management of CVADs, they can be treated successfully and long-term catheter survival rates are excellent.
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Affiliation(s)
- Olaf Beck
- Children's Hospital, Pediatric Hematology, Oncology and Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oliver Muensterer
- Children's Hospital, Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sarah Hofmann
- Children's Hospital, Pediatric Hematology, Oncology and Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jörg Faber
- Children's Hospital, Pediatric Hematology, Oncology and Hemostaseology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jan Gödeke
- Children's Hospital, Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Khalil GM, Azqul MM. Risk factors and microbial profile of central venous catheter related blood stream infection in medical cardiac care units, National Heart Institute, Egypt. Egypt Heart J 2018; 70:361-364. [PMID: 30591755 PMCID: PMC6303371 DOI: 10.1016/j.ehj.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/14/2018] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Catheter related blood stream infection (CRBSI) is the main complication of central venous catheter (CVC) use. The aim of the study is to improve the safety of patients with central venous catheter in National Heart Institute (NHI) medical cardiac care units. METHODS A Prospective cohort study was conducted on one hundred and eleven cardiac patients in (NHI) cardiac care units from August 2017 to February 2018. All patients subjected to central venous catheter (CVC) in cardiac care units, NHI, were included except: 1. Patients with obvious source of infection, 2. Immunocompromised patients, 3. patients having infective endocarditis, 4. patients whose catheter was put outside NHI. RESULTS Noncompliance of health care providers to care bundle elements of CVC of Centers for Disease Control and Prevention (CDC) represents a risk factor for CRBSI occurrence. Coagulase negative staphylococci was the most common isolated organism. CONCLUSION Health care providers should adhere care bundle elements recommended by CDC during insertion and handling of CVC. This will in turn decrease CRBSI.
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Affiliation(s)
- Ghada Mahmoud Khalil
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Egypt
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Wing VK, Song Y, Xiang C, Liu X, Macaulay D, Ponsillo M, Blumentals WA. Incidence of catheter-related complications among Japanese patients with central venous catheters as well as patients with short bowel syndrome. Clin Exp Gastroenterol 2018; 11:439-445. [PMID: 30568477 PMCID: PMC6276634 DOI: 10.2147/ceg.s172430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Short bowel syndrome (SBS) is a serious rare disorder that is usually managed with parenteral nutrition. Central venous catheter (CVC)-related complications are known to occur, but their incidence rates (IRs) in Japan are unknown. The aim of this study was to estimate the incidence of complications in Japanese patients with CVCs, including patients with SBS using CVCs. Patients and methods A retrospective cohort study in 64,817 patients with CVCs, including 81 patients with SBS, between April 2008 and October 2016 using a claims database in Japan was conducted. IRs of complications were calculated as total events divided by total catheter-days among all patients with CVCs and among patients with SBS. Results The majority (>90%) of patients in the CVC and SBS cohorts were ≥18 years old. Overall, IRs of any type of complication were numerically higher in patients with SBS compared with all patients with CVCs (2.68 vs 1.95 cases per 1,000 catheter-days, respectively). Among patients with SBS, septicemia, infection, and inflammatory reaction were the only complications observed. The complications with the highest incidence were catheter-related bloodstream infections (CRBSIs) in both the overall CVC cohort and the SBS cohort with IRs of 1.35 and 2.68 cases per 1,000 catheter-days, respectively. The IR of any CVC-related complication was numerically higher in patients with SBS with cancer vs without cancer (3.44 vs 1.86 cases per 1,000 catheter-days, respectively). Conclusion Our study quantifies the incidence of complications in patients with CVCs, including those with SBS, in Japan.
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Affiliation(s)
- Vicki K Wing
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Wójtowicz D, Cholewa D, Faba AM, Domańska B, Kokoszka J, Kopacz K, Ficek R, Irzyniec T, Rotkegel SE, Chudek J. Diabetes decreases patency of tunneled catheters in hemodialysis patients after first effective thrombolysis with urokinase. Ren Fail 2018; 40:384-389. [PMID: 30010473 PMCID: PMC6052429 DOI: 10.1080/0886022x.2018.1487856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fibrinolysis is one of the methods extending the use of vascular access in patients with tunneled venous catheters thrombosis. The aim of this study was to assess one-year maintenance of tunneled catheters patency after first effective thrombolysis with urokinase and identify its predictors. Methods: Retrospective analysis included 85 patients (age 69 ± 13 years) with permanent venous catheter thrombosis treated with urokinase at one center in the period 2010–2016. Urokinase was used (depending on weight) at a dose of 10,000 or 20,000 IU in an 8 h infusion to each catheter line. Assessment of one-year efficacy of fibrinolysis included the time between fibrinolysis and following thrombosis of the same catheter in patients that have previously obtained at least partial blood flow. The analysis included medication, comorbidities, catheter patency time and INR value during first thrombosis episode. Results: There were 62.4% patients with type-2 diabetes and 11.8% with neoplasm. The thrombolysis procedure was effective in 73 patients (85.9%). An analysis of the one-year efficacy of thrombolysis procedure included 73 patients. Among them, 23 experienced next episode of catheter-related thrombosis within a year postprocedure. Diabetes increased the risk for recurrent thrombosis [HR =3.19 (1.09-9.41); p = .03]. Conclusions: Patients with diabetes are at higher risk of recurrent catheter-related thrombosis and therefore may require more aggressive anticoagulation therapy for its prevention.
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Affiliation(s)
- Dominika Wójtowicz
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Dominika Cholewa
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Anna M Faba
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Beata Domańska
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Joanna Kokoszka
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Konrad Kopacz
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Rafał Ficek
- b Dialysis Center in Katowice "NEFROMED", Centrum Dializa Sosnowiec , Katowice , Poland.,c Department of Nephrology, Transplantation and Internal Medicine, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
| | - Tomasz Irzyniec
- d Department of Nephrology with Dialysis Unit , MSWiA Hospital , Katowice , Poland.,e Department of Health Promotion and Community Nursing, School of Health Sciences , Medical University of Silesia in Katowice , Katowice , Poland
| | - Sylwia E Rotkegel
- b Dialysis Center in Katowice "NEFROMED", Centrum Dializa Sosnowiec , Katowice , Poland
| | - Jerzy Chudek
- a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland.,b Dialysis Center in Katowice "NEFROMED", Centrum Dializa Sosnowiec , Katowice , Poland.,f Department of Internal Medicine and Oncological Chemotherapy, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland
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Maldonado-Cárceles AB, García-Medina J, García-Alfonso JJ, Árense-Gonzalo JJ, Torres-Cantero AM. Patency rates of dysfunctional central hemodialysis venous catheter: Comparison between catheter exchange alone and catheter exchange with fibrin sheath angioplasty. Diagn Interv Imaging 2018; 100:157-162. [PMID: 30262173 DOI: 10.1016/j.diii.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/10/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to compare patency rates and risk of obstruction of catheter exchange (CE) with that of CE with fibrin sheath angioplasty (CE+FSA) in dysfunctional tunneled central hemodialysis venous catheter (CHVC). MATERIALS AND METHODS A total of 107 consecutive patients with dysfunctional CHVC were retrospectively included. There were 66 men and 41 women with a mean age of 67.8±12.5 (SD) years (range: 23.0-86.0 years). Seventy-three of 107 patients (68.2%) underwent CE procedure and 34 of 107 (31.8%) underwent CE+FSA. Kaplan-Meier log-rank test and multivariate Cox regression analyses were performed to determine patency rates and risk of obstruction according to type of endovascular procedure. RESULTS Patency rates after endovascular procedures at 3, 6, 12, 24 and 36 months follow up were 75%, 75%, 65%, 65% and 65% in CE+FSA group and 70%, 65%, 62%, 30% and 0% in CE group. Mean time until obstruction of CHVC was 778.4 days after CE+FSA and 497 days after CE (P=0.211). Endovascular procedure was unrelated to risk of obstruction in adjusted model (HR=1.34; P=0.515). CONCLUSIONS Our findings suggest that both techniques are equivalent in terms of patency and safety results, so other aspects as cost assessment should be considered when choosing between both techniques.
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Affiliation(s)
- A B Maldonado-Cárceles
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, IMIB-Arrixaca, 30100 Espinardo, Murcia, Spain; Department of Preventive Medicine, General University Hospital "Reina Sofia", 30003 Murcia, Spain.
| | - J García-Medina
- Department of Vascular and Interventional Radiology, General University Hospital "Reina Sofia", 30003 Murcia, Spain
| | - J J García-Alfonso
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, IMIB-Arrixaca, 30100 Espinardo, Murcia, Spain
| | - J J Árense-Gonzalo
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, IMIB-Arrixaca, 30100 Espinardo, Murcia, Spain
| | - A M Torres-Cantero
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, IMIB-Arrixaca, 30100 Espinardo, Murcia, Spain; Department of Preventive Medicine, University Hospital "Virgen de la Arrixaca", 30120 El Palmar, Murcia, Spain
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Bell J, Goyal M, Long S, Kumar A, Friedrich J, Garfinkel J, Chung S, Fitzgibbons S. Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions. J Intensive Care Med 2018; 35:869-874. [PMID: 30231668 DOI: 10.1177/0885066618795126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. METHODS A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC's were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. RESULTS In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. CONCLUSIONS These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.
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Affiliation(s)
- Jacob Bell
- Georgetown University School of Medicine, Washington, DC, USA
| | - Munish Goyal
- Department of Emergency Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Sallie Long
- Georgetown University School of Medicine, Washington, DC, USA
| | - Anagha Kumar
- Medstar Health Research Institute, Hyattsville, MD, USA
| | | | | | - Suzi Chung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Shimae Fitzgibbons
- Department of General Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
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Convectively Dominated Heparin Leakage From Multiple Catheter Designs: An In Vitro Experimental Study. ASAIO J 2018; 64:e94-e104. [DOI: 10.1097/mat.0000000000000776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Makary MS, Lionberg A, Khayat M, Lustberg MB, AlTaani J, Pan XJ, Layman RR, Raman SV, Layman RM, Dowell JD. Advanced stage breast cancer is associated with catheter-tip thrombus formation following implantable central venous port placement. Phlebology 2018; 34:107-114. [PMID: 29771187 DOI: 10.1177/0268355518774442] [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: 01/23/2023]
Abstract
PURPOSE Catheter-tip associated thrombosis is not uncommon in patients with implantable central venous ports; however, the prevalence and clinical impact of this complication on patient management is unclear. This study aims to identify risk factors for thrombus formation in a large population receiving serial echocardiograms (echo) following port placement. METHODS A total of 396 female breast cancer patients underwent internal jugular vein chest port placement between 2007 and 2013 and received echo studies every third month. Catheter tip position was measured from chest radiography and catheter associated thrombus was identified by echo. RESULTS Sixteen out of 396 patients (4%) had catheter-tip thrombus. No patients were symptomatic or prophylactically anticoagulated. Patients with thrombus were significantly younger than those without (46.4 years versus 53.4 years, respectively, p = 0.02) and had higher stage breast cancer with 75% versus 44.7% having stage III or IV cancer ( p = 0.017). Thrombus was identified after a median of 91 days. No significant difference was identified in anatomic ( p = 0.1) or measured ( p = 0.15) tip position, port laterality ( p = 0.86), or number of port lumens ( p = 0.65). CONCLUSIONS In this large cohort, younger patients and those with more advanced stage breast cancer were more associated with catheter-tip-related thrombus after port placement.
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Affiliation(s)
- Mina S Makary
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Lionberg
- 2 Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Mamdouh Khayat
- 3 Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Maryam B Lustberg
- 4 Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jamal AlTaani
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xueliang J Pan
- 5 Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard R Layman
- 6 Division of Diagnostic Imaging, Department of Imaging Physics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Subha V Raman
- 7 Division of Cardiovascular Medicine, Department of Internal Medicine, Richard R. Ross Heart Hospital and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel M Layman
- 8 Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Joshua D Dowell
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,9 Northwest Radiology, St. Vincent Health, Indianapolis, IN, USA
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Arechabala MC, Catoni MI, Claro JC, Rojas NP, Rubio ME, Calvo MA, Letelier LM. Antimicrobial lock solutions for preventing catheter-related infections in haemodialysis. Cochrane Database Syst Rev 2018; 4:CD010597. [PMID: 29611180 PMCID: PMC6513408 DOI: 10.1002/14651858.cd010597.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients undergoing haemodialysis (HD) through a central venous catheter (CVC) are exposed to several risks, being a catheter-related infection (CRI) and a CVC lumen thrombosis among the most serious. Standard of care regarding CVCs includes their sealing with heparin lock solutions to prevent catheter lumen thrombosis. Other lock solutions to prevent CRI, such as antimicrobial lock solutions, have proven useful with antibiotics solutions, but not as yet for non-antibiotic antimicrobial solutions. Furthermore, it is uncertain if these solutions have a negative effect on thrombosis incidence. OBJECTIVES To assess the efficacy and safety of antimicrobial (antibiotic, non-antibiotic, or both) catheter lock solutions for preventing CRI in participants undergoing HD with a CVC. SEARCH METHODS We searched the Cochrane Kidney and Transplant Specialised Register up to 18 December 2017 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA We included all randomised or quasi-randomised control trials (RCTs) comparing antimicrobial (antibiotic and non-antibiotic) lock solutions to standard lock solutions, in participants using a CVC for HD, without language restriction. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for eligibility, and two additional authors assessed for risk of bias and extracted data. We expressed results as rate ratios (RR) per 1000 catheter-days or 1000 dialysis sessions with 95% confidence intervals (CI). Statistical analyses were performed using the random-effects model. MAIN RESULTS Thirty-nine studies, enrolling 4216 participants, were included in this review, however only 30 studies, involving 3392 participants, contained enough data to be meta-analysed. Risk of bias was low or unclear for most domains in the majority of the included studies.Studies compared antimicrobial lock solutions (antibiotic and non-antibiotic) to standard sealing solutions (usually heparin) of the CVC for HD. Fifteen studies used antibiotic lock solutions, 21 used non-antibiotic antimicrobial lock solutions, and 4 used both (antibiotic and non-antibiotic) lock solutions. Studies reported the incidence of CRI, catheter thrombosis, or both.Antimicrobial lock solutions probably reduces CRI per 1000 catheter-days (27 studies: RR 0.38, 95% CI 0.27 to 0.53; I2 = 54%; low certainty evidence), however antimicrobial lock solutions probably makes little or no difference to the risk of thrombosis per 1000 catheter days (14 studies: RR 0.79, 95% CI 0.52 to 1.22; I2 = 83%; very low certainty evidence). Subgroup analysis of antibiotic and the combination of both lock solutions showed that both probably reduced CRI per 1000 catheter-days (13 studies: RR 0.30, 95% CI: 0.22 to 0.42; I2 = 47%) and risk of thrombosis per 1000 catheter-days (4 studies: RR 0.26, 95% CI: 0.14 to 0.49; I2 = 0%), respectively. Non-antibiotic antimicrobial lock solutions probably reduced CRI per 1000 catheter-days for tunnelled CVC (9 studies: RR 0.60, 95% CI 0.40 to 0.91) but probably made little or no difference with non-tunnelled CVC (4 studies: RR 0.93, 95% CI 0.48 to 1.81). Subgroup analyses showed that antibiotic (5 studies: RR 0.76, 95% CI 0.42 to 1.38), non-antibiotic (8 studies: RR 0.85, 95% CI 0.44 to 1.66), and the combination of both lock solutions (3 studies: RR 0.63, 95% CI 0.22 to 1.81) made little or no difference to thrombosis per 1000 catheter-days compared to control lock solutions. AUTHORS' CONCLUSIONS Antibiotic antimicrobial and combined (antibiotic-non antibiotic) lock solutions decreased the incidence of CRI compared to control lock solutions, whereas non-antibiotic lock solutions reduce CRI only for tunnelled CVC. The effect on thrombosis incidence is uncertain for all antimicrobial lock solutions. Our confidence in the evidence is low and very low; therefore, better-designed studies are needed to confirm the efficacy and safety of antimicrobial lock solutions.
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Affiliation(s)
- Maria C Arechabala
- Pontificia Universidad Católica de ChileEscuela de EnfermeríaVicuna Mackenna 4860 MaculSantiagoRegion MetropolitanaChile7820436
| | - Maria I Catoni
- Pontificia Universidad Católica de ChileEscuela de EnfermeríaVicuna Mackenna 4860 MaculSantiagoRegion MetropolitanaChile7820436
| | - Juan Carlos Claro
- Pontificia Universidad Católica de ChileDepartamento de Medicina Interna, Programa de Salud Basada en Evidencia, Escuela de MedicinaLira 63, 1st floorSantiagoRegion MetropolitanaChile
| | - Noelia P Rojas
- Pontificia Universidad Católica de ChileEscuela de EnfermeríaVicuna Mackenna 4860 MaculSantiagoRegion MetropolitanaChile7820436
| | - Miriam E Rubio
- Pontificia Universidad Católica de ChileEscuela de EnfermeríaVicuna Mackenna 4860 MaculSantiagoRegion MetropolitanaChile7820436
| | - Mario A Calvo
- Universidad Austral de ChileEscuela de MedicinaFernando de Aragón 161. Valdivia OrganisationValdiviaRegión de Los LagosChile6720
| | - Luz M Letelier
- Pontificia Universidad Católica de ChileDepartamento de Medicina Interna, Programa de Salud Basada en Evidencia, Escuela de MedicinaLira 63, 1st floorSantiagoRegion MetropolitanaChile
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Hussein WF, Mohammed H, Browne L, Plant L, Stack AG. Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study. BMC Nephrol 2018; 19:76. [PMID: 29609535 PMCID: PMC5880000 DOI: 10.1186/s12882-018-0873-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/15/2018] [Indexed: 11/28/2022] Open
Abstract
Background Central venous catheters (CVC) are associated with substantial morbidity and mortality among patients undergoing haemodialysis (HD), yet they are frequently used as the primary vascular access for many patients on HD. The goal of this study was to determine the prevalence and variation in CVC use across centres in the Irish health system. Methods Data from the National Kidney Disease Clinical Patient Management System (KDCPMS) was used to determine CVC use and patterns across centres. Data on demographic characteristics, primary cause of end-stage kidney disease (ESKD), comorbid conditions, laboratory values and centre affiliation were extracted for adult HD patients (n = 1, 196) who were on dialysis for at least three months up to end of December 2016. Correlates of CVC use were explored using multivariable logistic regression. Results Overall prevalence of CVC use was 54% and varied significantly across clinical sites from 43% to 73%, P < 0.001. In multivariate analysis, the likelihood of CVC use was lower with increasing dialysis vintage, OR 0.40 (0.26–0.60) for 4 years vs 1 year vintage, rising serum albumin, OR 0.73 (0.59–0.90) per 5 g/L), and with cystic disease as a cause of ESKD, OR 0.38 (95% CI 0.21–0.6). In contrast, catheter use was greater for women than men, OR 1.77 (1.34–2.34) and for 2 out of 10 regional dialysis centres, OR 1.98 (1.02–3.84) and OR 2.86 (1.67–4.90) respectively compared to referent group). Conclusions Catheters are the predominant type of vascular access in patients undergoing HD in the Irish health system. Substantial centre variation exists which is not explained by patient-level characteristics. Electronic supplementary material The online version of this article (10.1186/s12882-018-0873-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wael F Hussein
- Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Husham Mohammed
- Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Liam Plant
- National Renal Office, HSE Clinical Programmes and Strategy Division, Dublin, Ireland.,Department of Renal Medicine, University College Cork, Cork, Ireland
| | - Austin G Stack
- Department of Nephrology, University Hospital Limerick, St Nessans Rd, Dooradoyle, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Yap HY, Pang SC, Tan CS, Tan YL, Goh N, Achudan S, Lee KG, Tan RY, Choong LHL, Chong TT. Catheter-related complications and survival among incident hemodialysis patients in Singapore. J Vasc Access 2018; 19:602-608. [DOI: 10.1177/1129729818765055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Hemodialysis is the main modality of renal replacement therapy in Singapore. However, a majority of the patients in Singapore are initiated on hemodialysis via a catheter. This study examines the complication rates and factors predicting catheter-related bloodstream infections and mortality rates in patients who were initiated on hemodialysis at our institution. Methods: This is a single-center retrospective analysis of incident hemodialysis patients who were initiated on renal replacement therapy between 1 January 2010 and 31 December 2012. Catheter-related bloodstream infection risk factors, organisms, and associated mortality were analyzed. Results: The catheter-related bloodstream infection and exit site infection incidence rates were 0.75 and 0.50 per 1000 catheter days, respectively. The mean duration to first catheter-related bloodstream infection episode was 182.47 ± 144.04 catheter days. Prolonged catheter duration was found to be a risk factor for catheter-related bloodstream infection. Compared to patients initiated on dialysis via arteriovenous fistula, initiation of dialysis via catheter is strongly associated with increased mortality (6.0% vs 14.5%; p = 0.02). In particular, the presence of diabetes mellitus and development of catheter-related bloodstream infection was associated with increased mortality ( p = 0.04 and 0.05, respectively). In addition, patients who began hemodialysis before being seen by a nephrologist were associated with decreased mortality (3.4% vs 13.0%; p = 0.03). Conclusion: In conclusion, prolonged duration of catheter insertion is found to be a risk factor for catheter-related bloodstream infection in hemodialysis patients, and its development is associated with increased mortality. Early referral to a nephrologist and creation of arteriovenous fistula in pre-end-stage renal disease patients are pivotal in improving the outcomes of patients.
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Affiliation(s)
- Hao-Yun Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Suh-Chien Pang
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chieh-Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yi-Liang Tan
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Nicholette Goh
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Shaam Achudan
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Kian-Guan Lee
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Ru-Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Tze-Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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Abstract
Over half of the nearly two million healthcare-associated infections can be attributed to indwelling medical devices. In this review, we highlight the difficulty in diagnosing implantable device-related infection and how this leads to a likely underestimate of the prevalence. We then provide a length-scale conceptualization of device-related infection pathogenesis. Within this conceptualization we focus specifically on biofilm formation and the role of host immune and coagulation systems. Using this framework, we describe how current and developing preventative strategies target specific processes along the entire length-scale. In light of the significant time horizon for the development and translation of new preventative technologies, we also emphasize the need for parallel development of in situ treatment strategies. Specific examples of both preventative and treatment strategies and how they align with the length-scale conceptualization are described.
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49
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Affiliation(s)
- Susie Q. Lew
- Division of Renal Diseases and Hypertension Department of Medicine, George Washington University Washington, DC, USA
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50
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Barretta LM, Beccaria LM, Cesarino CB, Pinto MH. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service. Rev Lat Am Enfermagem 2017; 24:S0104-11692016000100331. [PMID: 27276021 PMCID: PMC4915799 DOI: 10.1590/1518-8345.0547.2698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022] Open
Abstract
Objective: to identify the model, average length of stay on site and complications of central
venous catheter in patients undergoing transplant of hematopoietic stem cells and
verify the corresponding relationship between the variables: age, gender, medical
diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted
records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on
site of 47.6 days. The complication fever/bacteremia was significant in young
males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained
with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between
the catheter insertion and start of the conditioning regimen, as well as not to
extend the length of time that catheter should be on site and undertake their
continuing education, focusing on the prevention of complications.
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Affiliation(s)
- Lidiane Miotto Barretta
- RN, Centro de Educação Permanente, FUNFARME, São José do Rio Preto, SP, Brazil., Centro de Educação Permanente, FUNFARME, São José do Rio Preto SP , Brazil
| | - Lúcia Marinilza Beccaria
- Adjunct Professor, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil., Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto SP , Brazil
| | - Cláudia Bernardi Cesarino
- Adjunct Professor, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil., Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto SP , Brazil
| | - Maria Helena Pinto
- Professor, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil., Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto SP , Brazil
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