A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters

Ling, Xiao Chun; Lu, Hsi Peng; Loh, El Wui; Lin, Yen Kuang; Li, Yi Shiuan; Lin, Cheng Hsin; Ko, Yu Chen; Wu, Mei Yi; Lin, Yuh Feng; Tam, Ka Wai

doi:10.1016/j.jvs.2018.09.029

Cited by 18 publications

(15 citation statements)

References 20 publications

(112 reference statements)

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“…Third, mechanical catheter design may change catheter rheology, but does not affect the risks for thrombosis and infection and hence catheter survival. 23,24 However, the effect of the catheter design was not fully considered in this study.…”

Section: Discussionmentioning

confidence: 99%

Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study

Wang

et al. 2019

J Vasc Access

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Introduction: Central venous catheter insertion for long-term vascular access is not recommended in clinical practice. However, since arteriovenous fistula creation is difficult to perform in some patients, central venous catheter insertion for long-term vascular access is performed. This study aimed to assess the complications and service time of central venous catheters replaced using different methods and to determine the influencing factors of service time. Methods: Study design: A retrospective observational cohort study. Setting and participants: Patients who underwent tunneled dialysis catheter malfunction (2009–2019) and had to undergo another dialysis catheter insertion were enrolled. Exposures: Ectopic replacement and in situ replacement. Outcomes: Factors such as age, sex, primary patency rate, secondary patency rate, early complications, and late complications were considered. Analytical approach: This study used a Cox proportional hazards regression model. Results: The first and the newly replaced catheter service time were 37.779 ± 24.563 months and 32.468 ± 26.638 (25) months in the ectopic group and 37.075 ± 20.550 months and 26.349 ± 22.672 months in the in situ group, respectively. In the early service time, the newly replaced catheter resulted in significant bleeding from the tunnel. The first catheter had the least complications, most adequate blood flow, and longest service time. Ectopic catheter replacement and the tip shape of the catheter were the independent factors for catheter service time. Catheter service time increased with age. Conclusion: Ectopic catheter replacement can improve the primary patency rate and auxiliary primary patency rate of catheters. Ectopic catheter replacement may require sufficient surgical skills with digital subtraction angiography, resulting in a better prognosis.

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Section: Discussionmentioning

confidence: 99%

Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study

Wang

et al. 2019

J Vasc Access

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“…Due to their widespread use, every effort should be made to minimize the number of complications and ensure the longest possible period of functioning. The most common complications associated with central catheters include intra- or pericatheter thrombosis (catheter related thrombosis—CRT) and catheter-related bloodstream infections (CRBSI) [ 4 ]. Malfunction and CRT are responsible for 30–40% of cases of loss of vascular access [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Locked Away—Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis

Szymańska

Kakareko

Rydzewska–Rosołowska

et al. 2021

JCM

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Reliable vascular access is necessary for effective hemodialysis. Guidelines recommend chronic hemodialysis via an arteriovenous fistula (AVF), however, in a significant number of patients, permanent central venous catheters (CVCs) are used. The use of a tunneled catheter is acceptable if the estimated dialysis time is less than a year or it is not possible to create an AVF. The main complications associated with CVC include thrombosis and catheter-related bloodstream infections (CRBSIs), which may result in loss of vascular access. The common practice is to use locking solutions to maintain catheter patency and minimize the risk of CRBSI. This paperwork summarizes information on currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction. The PubMed database was systematically searched for articles about locking solutions used in permanent CVCs in hemodialysis patients. Additional studies were identified by searching bibliographies and international guidelines. Articles on end-stage kidney disease patients dialyzed through a permanent CVC were included. Information from each primary study was extracted using pre-determined criteria including thrombotic and infectious complications of CVC use, focusing on permanent CVC if sufficient data were available. Of the currently available substances, it seems that citrate at a concentration of 4% has the best cost-effectiveness and safety profile, which is reflected in the international guidelines. Recent studies suggest the advantage of 2+1 protocols, i.e., taurolidine-based solutions with addition of urokinase once a week, although it needs to be confirmed by further research. Regardless of the type of locking solution, if prophylaxis with a thrombolytic agent is chosen, it should be started from the very beginning to reduce the risk of thrombotic complications. In case of CVC dysfunction, irrespective of the thrombolysis attempt, catheter replacement should be planned as soon as possible.

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“…Validating this hypothesis requires attention to potential confounders arising from other disparities in the tip design. 24 The number of these confounders may be reduced by limiting the number of design dissimilarities to the extent possible; for instance, by not comparing staggered-tip (also known as step-tip) and symmetrical tip catheters.…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus aureus accumulation at the tip of hemodialysis catheters with or without tip side holes in catheter related bloodstream infection in a large animal

Tal

Yevzlin

2021

J Vasc Access

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Background: Eighty percent of hemodialysis patients start their dialysis with a tunneled hemodialysis catheter. Catheter related bacteremia is the second most common cause of death in these patients. Side holes near the tips of the tunneled cuffed central venous catheters are associated with accumulation of thrombus, which can lead to catheter dysfunction and, possibly, also to catheter-related infection. To assess the hypothesis that a catheter without side holes would be associated with less bacterial growth, this study compared the susceptibility of a side-hole-free catheter to accumulation of pathogenic bacteria at the catheter tip with that of two catheters which have side holes. Methods: Eight tunneled cuffed double-lumen central venous catheters were inserted into both jugular veins of four sheep; one side-hole-free and one control catheter with side holes at the tip in each animal. Staphylococcus aureus bacteria were then infused intravenously to cause bacteremia. Six hours later, the catheters were removed, the clots that accumulated in their tips were collected and cultured, and the bacterial colonies were counted after additional 12 h of incubation. Results: Bacteria grew on culture plates seeded with the clot homogenate obtained from the tips of all catheters. The colony counts from the catheters with side holes at the tip exceeded the colony counts of bacteria accumulated in the tips of the side-hole-free hemodialysis catheters by one or more orders of magnitude, with a difference of at least two orders of magnitude observed in three of the four intra-animal comparisons. Conclusions: In paired intra-animal post-inoculation comparison made in this limited study, fewer colony forming units of pathogenic bacteria accumulated at the tip of the side-hole-free catheters than at the tips of the catheters which have side holes. This may translate to a decreased rate of catheter-related blood stream infections in the side-hole-free catheters.

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A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters

Cited by 18 publications

References 20 publications

Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study

Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study

Locked Away—Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis

Staphylococcus aureus accumulation at the tip of hemodialysis catheters with or without tip side holes in catheter related bloodstream infection in a large animal

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