Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: A randomized controlled study

Parienti, Jean‐Jacques; Mégarbane, Bruno; Fischer, Marc-Olivier; Lautrette, Alexandre; Gazui, Nicole; Marin, Nathalie; Hanouz, Jean‐Luc; Ramakers, Michel; Daubin, Cédric; Mira, Jean‐Paul; Charbonneau, P.; Cheyron, Damien du

doi:10.1097/ccm.0b013e3181d454b3

Cited by 122 publications

(111 citation statements)

References 33 publications

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“…In addition, the URR were comparable between routes. The results of this crossover design confirm those we found using a parallel design (7,8). Our findings are in accordance with new guidelines from the Centers for Disease Control and Prevention (11) for preventing central catheter infection, but contrast with the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Vascular Access (6).…”

Section: Discussionsupporting

confidence: 80%

“…However, a parallel experiment from our group (7) showed that this might not be the case in ICU. In addition, the incidences of catheter bloodstream infections (7) or catheter dysfunction (8), as well as urea reduction ratios (URR) (8), were similar between randomized groups. Any unexpected result derived from a single study must be confirmed by other studies before translating evidence base into routine clinical practice.…”

Section: Introductionmentioning

confidence: 85%

“…A crossover study was thus designed among patients from the Cathedia study who consecutively received a first and a second CVC in the two different sites of insertion (femoral or jugular). Details regarding catheter lengths, types, materials, care, RRT, and dialysis procedures (which were similar between the first and second catheters within each center) were described previously (7,8). The institutional review board at Caen University Hospital approved this study.…”

Section: Study Design Settings and Populationmentioning

confidence: 99%

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Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Dugué

Levesque²,

Fischer

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Several temporary venous catheterizations are sometimes required for acute renal replacement therapy (RRT) in the intensive care unit (ICU). This study compares first and second catheterizations in the femoral and jugular veins in terms of patient safety.Design, setting, participants, & measurements A crossover study from the catheter-dialysis randomized study (Cathedia), which was conducted among 736 critically ill adults requiring RRT, was performed. Catheter insertion complications, catheter-tip colonization, catheter dysfunction and urea reduction ratio (URR) were analyzed considering the crossover and longitudinal designs.Results This study analyzed 134 patients who underwent two different sites of catheterization, 57 and 77 of whom were initially randomized in the femoral and jugular site, respectively. Using anatomic landmarks, time to insert a femoral catheter was shorter (P=0.01) and more successful (P=0.003) compared with catheterization in the jugular site. Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion (median, 14 days in both groups; hazard ratio, 0.99; 95% confidence interval, 0.61-1.59; P=0.96), as well as time to dysfunction. URRs were analyzed from 395 dialysis sessions (n=48 patients). No significant difference (P=0.49) in mean URR was detected between sessions performed through femoral (n=213; 50.9%) and jugular (n=182; 49.5%) dialysis catheters.Conclusions These results validate prior results of this study group and extend external validity to the second catheter used for RRT in the ICU. Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 85%

Section: Study Design Settings and Populationmentioning

confidence: 99%

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Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Dugué

Levesque²,

Fischer

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…However, this is a single-center study and its findings may not apply to centers that prefer to use catheter insertion at other sites. We note that randomized controlled trials 18 show no difference in catheter dysfunction rate between jugular or femoral access. These observations support the view that the use of the femoral vein for CRRT is rational and justified, perhaps with the possible exception of obese patients.…”

Section: Strengths and Limitationsmentioning

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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“…The Cathedia study found lower rates of dysfunction in catheters placed in the RIJ, and femoral veins compared with the LIJ site. 26 Attention to both anticoagulation and line site may thus reduce interruptions.…”

mentioning

confidence: 99%

Renal replacement therapy in Scottish critical care units: A national audit of practices

Black

Chalmers

Wallis

et al. 2014

Journal of the Intensive Care Society

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Large randomised controlled trials show no benefit of high intensity renal replacement therapy compared to lower intensity regimens. Previous data suggest large variation in practice. This audit evaluated practices in relation to intensity of replacement therapy in critical care units across the Scottish National Health Service over a 28-day period. The mean delivered weight-adjusted effluent flow rates for continuous veno-venous haemofiltration were 29.1 (8.1 SD) ml kg À1 h À1which was 89% of that prescribed. For continuous veno-venous haemodiafiltration, the mean delivered dose was 41.3 (7.9) ml kg À1 h À1 which was 88.4% of that prescribed. Of the eight patients undergoing intermittent haemodialysis, seven had daily treatments, whilst the eighth had four treatments in five days. The prescription and delivery of renal replacement therapy within Scottish critical care units are routinely performed at an intensity that is higher than necessary. Avoidance of excessive dose could provide important cost savings.

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Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: A randomized controlled study

Abstract: In terms of catheter dysfunction and dialysis performance among critically ill adults requiring acute renal replacement therapy, jugular site did not significantly outperform femoral site placement.

Cited by 122 publications

References 33 publications

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

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

Renal replacement therapy in Scottish critical care units: A national audit of practices

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