Approach to thrombotic occlusion related to long-term catheters of hemodialysis patients: a narrative review

Abstract

Currently, permanent catheters (pCVC) are becoming an alternative vascular access for long-stay patients in whom arteriovenous access cannot be made. Occlusion is a commun mechanical complication related to pCVC, leading to inadequate dialysis dose and frequent changes of local catheter location, which can cause exclusion of vascular sites. The aim of this study was to perform a narrative review of treatment of pCVC thrombotic occlusion in HD patients. The treatment of CVCP thrombosis typically consists on the saline infusion or administration of thrombolytics such as tissue plasminogen activated, reteplase and urokinase. There are few studies on the use of alteplase in pCVC clogged in oncology area and in dialysis population, and they all report success with the use of thrombolytic therapy ranging from 80-95% of cases, using 1mg/ml. Due to the high cost of alteplase, studies have suggested that cryopreservation and fractionated alteplase dose have made its use financially viable.

Prevalência E Fatores Associados Para a Ocorrência De Eventos Adversos No Serviço De Hemodiálise

“…The best access route to obtain these results is the AVF, however in this research the majority of the individuals had central venous catheters access in at least one period of the research. 2,22 Catheters, on the other hand, due to their own characteristics, generally do not allow an ideal blood flow; in addition, there are common complications such as clot obstruction and the consequent presence of hypoflow. 2,22 A study that evaluated transjugular catheter tips used in chronic dialysis by means of imaging tests, identified at least one thrombotic complication in 25 of the 38 study participants.…”

“…2,22 Catheters, on the other hand, due to their own characteristics, generally do not allow an ideal blood flow; in addition, there are common complications such as clot obstruction and the consequent presence of hypoflow. 2,22 A study that evaluated transjugular catheter tips used in chronic dialysis by means of imaging tests, identified at least one thrombotic complication in 25 of the 38 study participants. 23 Another study conducted in China with 865 patients undergoing dialysis using catheters found that 56.65% of the sample had catheter dysfunction and 38.61% of the patients developed a catheter infection.…”

“…One hypothesis raised by this study is that access to Long-term CVC is related to the occurrence of AEs due to its own characteristics, leading to obstruction and difficulty in maintaining high blood flows, as previously discussed. 22 In turn, the variable treatment time of less than one year, may be related to the occurrence of AEs due to the first year of hemodialysis treatment being a period of adaptation for these patients. Firstly, because they are patients who frequently arrive at the service on an emergency basis, with complications related to uremia, which requires more complex care.…”

Learning culture in nephrology / Cultura de aprendizagem em nefrologia / La cultura del aprendizaje en nefrología

“…A fístula arteriovenosa autóloga, por exemplo, é a que mais atende a essas características e pode permanecer até cinco anos ou mais. Outros acessos que também podem ser utilizados são o enxerto arteriovenoso e o cateter de duplo lúmen (11) .…”

Approach to the occluded permanent hemodialysis catheter

“…Currently, permanent CVCs (pCVCs) are preferred for patients requiring long-term dialysis and in case that arteriovenous access is not possible (3). Occlusion, a common Bagcilar Medical Bulletin, Volume 2, Number 3, September 2017 complication in pCVCs, leads to an insufficient dialysis dose and locational changes of the catheter, which may end up with rejection on the vascular site (3).…”