A Comparison of the Niagara™ and Medcomp™ Catheters for Continuous Renal Replacement Therapy

Abstract

Purpose: The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT). In particular, differences in catheter design might affect the incidence of circuit clotting related to catheter malfunction. Design and setting: Sequential controlled study in a tertiary, adult intensive care unit (ICU). Aim: To compare circuit life when CRRT was performed with a Niagara™ catheter or a Medcomp™ catheter. Patients and measurements: We studied 46 patients with acute kidney injury requiring CRRT, all delivered with catheters in the femoral position. We obtained information on age, gender, disease severity score [acute physiology and chronic health evaluation (APACHE II) and APACHE III], filter life, heparin dose per hour, daily systemic hemoglobin concentration, platelet count, international normalized ratio (INR), and activated partial thromboplastin time (APTT) during CRRT. Results: We studied 254 circuits in 46 patients. Of these, 26 patients (140 circuits) used the Niagara catheter and 20 patients (114 circuits) used the Medcomp catheter. Median circuit life in the two groups were 11 h and 7.3 h, respectively ( p < 0.01). Patients using Medcomp catheters had a lower platelet count ( p ¼ 0.04) and a lower hemoglobin concentration (, and heparin dose per hour ( p ¼ 0.24) were similar. After correcting for confounding variables by multivariable linear regression analysis, it was found that the choice of catheter is not an independent predictor of circuit life. On Kaplan-Meier survival analysis, circuit life was not significantly different between the two catheters ( p ¼ 0.87). Conclusion: The choice of either the Niagara or Medcomp catheter does not appear to be a significant independent determinant of circuit life during CRRT.

Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

“…Of note, in routine clinical practice filter lifespans are often poorer than those reported in patients recruited into controlled clinical trials even in very experienced hands [17]. In particular, other factors such as line position and length can affect filter lifespan independent of anticoagulation [18]; in our pilot, patients with catheter tips sited in the superior vena cava or right atrium had significantly longer lifespan than those in the brachiocephalic vein or in the inferior vena cava (data not shown) emphasizing that the effective use of RCA does not obviate the need for other elements of best practice in CRRT delivery such as obtaining best vascular access.…”

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis

“… Variables associated with circuit life span Age > 18y, CVVH, ICU LOS > 72 hours Pregnant, age >80, contra-indication to heparin, HITT, high bleeding risk Multivariate Analysis Controlling for other variables Brunner et al 2013 [ 67 ] 16 patients/37 filters Prospective physican choice AT3/Heparin. Retrospective Analysis CRRT in Hepatic Failure with AKI Physician Choice N/A Antithrombin administration Heparin Fealy et al 2013 [ 93 ] 46 patients/254 filters Prospective Cohort Comparison of Niagara & Medcomp catheters CVVH IHD Medcomp 13.5Fr 24 cm O-O Niagara 13.5Fr 24 cm D-D Hwang et al, 2013 [ 60 ] 222 patients/1236 filters Retrospective Cohort Nefamostat vs Heparin CRRT treated patients 1/2004 to 12/2008 deceased within first filter use, paraquat poisoning APTT (sec) Controlling for other variables Dunn & Sriram, 2014 [ 23 ] 355 patients/1332 Retrospective Cohort Patient and Treatment Variables on Filter Life All CRRT 1/2008 to 8/2011 N/A Multivariate Analysis Controlling for other variables Fu et al, 2014 [ 41 ] 425 patients/425 filters Prospective cohort Prognostic model of circuit life 1/2011 to 2/2013, CRRT, age > 18, CRRT > 24 hrs, available blood analysis <72 hr post cardiac surgery, ECMO Rx Multivariate Analysis Controlling for other variables Wang et al 2014 [ 36 ] 34 patients/126 filters Prospective Cohort Study Effect of mobilisation on filter life 8/2011 to 8/2012, CRRT, temporary vascular access permanent vascular access, SLED Filter Life in Mobilisation Baseline Filter Life Choi et al, 2015 [ 30 ] 60 patients/101 filters Unblinded RCT …”

Clinical Survey of Decreased Blood Flow Rate in Continuous Renal Replacement Therapy: A Retrospective Observational Study

“…However, neither were significantly associated with a decreased blood flow rate. In addition, although the vascular access catheters used in the current study were uniform for all patients, in recent years, there has been an increase in the number of vascular access catheter types, which differ with size (external or internal diameter) or structure (lumen shape or design of holes) [17, 18]. It is possible that differences in the type of vascular access catheter may be associated with the decreased blood flow rate.…”