An Ex-Vivo Evaluation of Vascular Catheters for Continuous Hemofiltration

Tan, Han Khim; Bridge, Nicholas; Baldwin, Ian; Bellomo, Rinaldo

doi:10.1081/jdi-120015678

Cited by 7 publications

(5 citation statements)

References 8 publications

(8 reference statements)

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“…However, this methodology leads to increased risk of bleeding and ignoring the factors related to inadequate vascular access that may be of similar importance in the pathogenesis of circuit clotting. 5 In our study, both the catheters were associated with different blood flow resistances over the specified blood flow rate which is in congruence with Tan et al 5 Straight extension catheters offered lower resistance as compared to curved extension catheters and proved to be an ideal choice for CRRT. Higher blood flow resistance may result in access pressure alarms indicating a failure to maintain EC blood flow.…”

Section: Discussionsupporting

confidence: 89%

“…12 Moreover, this response may be aggravated in the presence of high resistance offered by the dual-lumen catheters causing oscillatory pressure changes leading to perpetuating endothelial pathological response. Therefore, a vicious cycle sets in, which corrodes the adequacy of CRRT 5 . These factors are usually unavoidable; however, the type and design of catheters chosen can be manipulated and might help in reducing several stressors impairing blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…3 Vascular access is one of the primary requirements of successful RRT 4 and its adequate patency allows smooth management of extracorporeal (EC) blood circuit. 5 Appropriate functioning of the catheter during CRRT allows effective and adequate urea clearance. In animal practice, central venous catheters are the traditional form of vascular access 4 and the jugular vein is the established site preferable in small animals.…”

Section: Introductionmentioning

confidence: 99%

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Comparative evaluation of straight and curved extension dialysis catheters for continuous renal replacement therapy in dogs with acute kidney injury

Bhat

Chandrasekar

Nambi

et al. 2023

Preprint

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A patent dual lumen dialysis catheter is one of the basic requirements for efficient extracorporeal (EC) therapy. The objective of this study was to measure resistance to blood flow offered by straight and curved extension dual lumen dialysis catheters used for continuous renal replacement therapy (CRRT). Twenty dogs suffering from acute kidney injury (AKI) were subjected to CRRT. The dogs were allocated randomly to Group-I (Curved extension catheter, n=12) or Group-II (Straight extension catheter, n=8), based on the type of dual-lumen catheter used in CRRT. The catheter outflow and inflow pressures were recorded at blood pump speeds of 50 mL/min and 99-100 mL/min. Data were tested for normality and differences in mean inflow and outflow catheter resistances were evaluated for statistical significance using independent samples t tests. Straight extension catheters offered lower inflow resistance than curved extension catheters at both 50 mL/min (41.50 ± 5.84 mm Hg and 63.75 ± 6.88 mm Hg, respectively; P=0.03) and 99-100 mL/min (63.00 ± 8.11 mm Hg and 86.92 ± 7.02 mm Hg, respectively; P=0.04) blood flow rates. Straight extension catheters also offered lower outflow resistance than curved catheters at 99-100 mL/min (-94.12 ± 7.91 mm Hg and -128.25 ± 7.56 mm Hg, respectively; P=0.01; the negative signs only indicate the direction of blood flow). These findings suggest that straight extension dual lumen dialysis catheters would likely perform better than the curved model in extracorporeal renal replacement therapy.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative evaluation of straight and curved extension dialysis catheters for continuous renal replacement therapy in dogs with acute kidney injury

Bhat

Chandrasekar

Nambi

et al. 2023

Preprint

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“…14,15 Such studies have shown that large gauge (>13 Fr) catheters pose significantly lower resistance to flow than small gauge catheters [13] and that, among long catheters (>19 cm), the Niagara catheter posed the lowest resistance to flow.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

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

et al. 2013

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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.

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“…Because high-volume hemofiltration meanwhile becomes of greater interest for therapy of sepsis and multiple organ failure, our results may be quite helpful for overcoming low-flow problems from the side of vascular access in many patients. The use of alternative principles such as a 'dual-vein approach' could also reduce the filter clearance limitations due to high Pv levels as investigated and recently published elsewhere [ 8 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Dual-lumen catheters for continuous venovenous hemofiltration: limits for blood delivery via femoral vein access and a potential alternative in an experimental setting in anesthetized pigs

et al. 2007

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An Ex-Vivo Evaluation of Vascular Catheters for Continuous Hemofiltration

Abstract: Proprietary hemofiltration catheters have variable resistance to blood flow under standard ex-vivo conditions. This ex-vivo information might be useful to clinicians in guiding their choice of catheters for clinical use.

Cited by 7 publications

References 8 publications

Comparative evaluation of straight and curved extension dialysis catheters for continuous renal replacement therapy in dogs with acute kidney injury

Comparative evaluation of straight and curved extension dialysis catheters for continuous renal replacement therapy in dogs with acute kidney injury

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

Dual-lumen catheters for continuous venovenous hemofiltration: limits for blood delivery via femoral vein access and a potential alternative in an experimental setting in anesthetized pigs

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