Analysis of Early Failure of Tunneled Hemodialysis Catheters

Abstract

By paying careful attention to catheter tip position, searching diligently for the presence of a fibrin sheath when catheter exchanges are made over a wire, and better investigating presumed catheter infection, we could reduce the early failure rate by more than half, from 46 cases to 20 cases (nine cases of suspected infection were in fact not infected).

Effect of ultra‐low dose and standard heparin locks on early tunnelled dialysis catheter outcomes in low‐risk dialysis patients

“…What good is a heparin lock in reducing bleeding if it increases catheter thrombosis? Our early malfunction rate of 3.3% is consistent with that obtained by Wong et al ., who reported a rate of 4.6% by day 7 post‐insertion in mainly IJV placements performed by radiologists . The difference though was that our malfunctions were amenable to thrombolytics or more concentrated heparin locks resulting in only one loss of patency compared with 100% loss in their series.…”

Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

“…In concordance with other studies, catheters were exchanged over guide wires with appropriate antibiotic therapy to deal with catheter-related bacteriemia. [15,19,20] Poor blood flows on dialysis or catheter blockage were significantly more frequent for Permcaths versus AshSplits in our population. This was confirmed by the increased use of tPA for Permcaths.…”

“…[17] Surprisingly, in one group, 75% of removed catheters suspected of infection did not yield any bacteria on culture of the catheter tips, suggesting that these catheters did not need to be removed. [15] In a recent study, somewhat surprisingly, there was no statistically significant risk factor that was a predictor of infection rate. [18] Some of our operators felt that catheter-related sepsis may be contributed to by excessive catheter handling; the operators changed sterile gloves before inserting the catheters and the sterile drapes which the catheter comes in contact with, but this had no effect on reducing catheter-related sepsis.…”

“…There is controversy among authors as to whether prophylactic antibiotics are necessary on catheter insertion, with some advocating treating patients with tunneled catheters on a par with patients with prosthetic cardiac valves, thus necessitating prophylactic antibiotics for all interventions, [14] while other authors don't give any prophylaxis. [15] Controversy also exists as to the appropriate method of treatment once systemic sepsis is confirmed and the catheter is felt to be infected. Successful reports of management of catheter related sepsis with antibiotics have avoided the necessity of catheter removal, with 100% bacteriemia eradication reported.…”

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

“…Ultrasound-guided venous puncture and realtime fluoroscopy during placement reduce complication and increase technical success [3,6,7]. The causes of early HD catheter (HDC) failure (defined as catheter removal within 7 days of insertion) include catheter-related infection, catheter tip misposition, catheter thrombosis, catheter kink, bleeding, and presence of existing fibrous sheath [8]. According to Wong et al [8], catheter tip misposition is the main cause of early catheter removal, accounting for 19.6% of early catheter failure.…”