Central Venous Catheters for Maintenance Hemodialysis: A Cautionary Approach

Swartz, Richard D.; Boyer, C; Messana, Joseph M.

doi:10.1016/s1073-4449(97)70035-9

Cited by 10 publications

(9 citation statements)

References 68 publications

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“…Surgically placed arteriovenous fistulas remain the preferred method for hemodialysis [2] with prosthetic bridge grafts comprising the majority of fistulas created in the United States [4]. However, dialysis patients often have had repeated or prolonged placement of temporary catheters, with the incidence of catheter-related subclavian vein stenosis reported to be as high as 40% [3].…”

Section: Discussionmentioning

confidence: 99%

“…of paramount importance [1]. Although indwelling central venous access catheters can provide temporary access, long-term access via surgically placed arteriovenous fistulas or shunt-grafts is preferred whenever possible [2]. Unfortunately, the incidence of catheterrelated subclavian vein stenosis has been reported to be as high as 40% [3].…”

Section: Introductionmentioning

confidence: 99%

“…Arteriography is indicated only in cases of possible vascular injury with active bleeding, and its primary function is to direct treatment using selective embolization [1][2][3].…”

mentioning

confidence: 99%

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Use of a puncture needle for recanalization of an occluded right subclavian vein

Gupta

Murphy

Soares

1998

Cardiovasc Intervent Radiol

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We report a patient in whom we used a puncture needle to initiate percutaneous recanalization of a chronic occlusion of the junction between the right subclavian vein and the right brachiocephalic vein. Under fluoroscopic guidance, an 18-gauge needle was used to puncture the right subclavian vein. When contrast material injected through the needle confirmed intravascular location, the needle was advanced until it deflected and perforated an occlusion balloon target positioned within the right brachiocephalic vein. This technique may be useful in patients with central venous occlusions that are refractory to traversal using traditional catheter and guidewire techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of a puncture needle for recanalization of an occluded right subclavian vein

Gupta

Murphy

Soares

1998

Cardiovasc Intervent Radiol

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“…Few patients have been able to achieve this goal and most require several access sites and repair procedures over the years [1][2][3]. The situation is particularly distressing for those patients using catheters for their primary access.…”

Section: Introductionmentioning

confidence: 99%

“…The number of patients using catheters 1 month into their ESRD treatment was reported to have increased from 15% of HD patients to over 40% from 1991 to 1994 [3]. The 2001 Atlas of ESRD in the USA reported a 71% increase in the insertion rate of permanent catheters per 1,000 patientyears at risk from 1996 to 1999, with a rate of catheter insertions (temporary and permanent) in 1999 of 590 catheter insertions per 1,000 patient-years.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Hemodialysis Catheter-Related Bloodstream Infection Using an Antimicrobial Lock

Quarello

Forneris²

2002

Blood Purif

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Among currently available vascular access options for hemodialysis, central venous catheters show the poorest reliability, with frequent complications of thrombosis and stenosis impairing patency. The most serious problem, however, is catheter-related bloodstream infection (CRBI), which is typically a cause for removal of the catheter and protracted systemic antibiotic therapy. In our experience, a totally implanted device (Dialock^®, Biolink Corp.) seems to confer a better global protection against catheter-related infections than standard tunneled catheters, accounting for 0.97 vs. 4.75 infection episodes/1,000 catheter-days, respectively (p < 0.001). Bloodstream infection rates, however, are not statistically different in the two groups (0.85 vs. 0.81 per 1,000 catheter-days; p = n.s.), indicating that the improvement is mainly related to local cutaneous infections. On the other hand, in the Sodemann experience, a new taurolidine-based lock solution (Neutrolin^®, Biolink Corp.) greatly reduced CRBI rates with both subcutaneous ports and tunneled catheters to 0.29 and 0.20 episodes/1,000 catheter-days, respectively. These promising results await further confirmation from ongoing clinical trials.

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Perforation der V. cava superior bei unerkannter Stenose

Schummer¹,

Schummer²,

Fritz³

2001

Der Anaesthesist

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We report on a case of fatal perforation of the superior vena cava. The perforation occurred after catheterization of the left internal jugular vein with a hemodialysis catheter, due to an unrecognised stenosis of the superior vena cava. Vascular trauma induced by a previous, also left-sided, subclavian vein-hemodialysis catheter (in place for 14 days), seemed to be the most likely pathomechanism of the stenotic lesion. It should be emphasised that this is a frequent complication especially of left-sided dialysis catheters. In the case described a stenosis was complicated by a misdirected second hemodialysis catheter. Although being repositioned under fluoroscopic control via a guide wire, an extravasal placement occurred but was unrecognised. In order to rule out catheter misplacement, the position of every central venous catheter has to be controlled. Standard methods are either chest X-ray or right atrial electrocardiography. Additionally, confirmation of correct intravenous placement requires a combination of free venous backflow of all lumen and/or blood gas analysis or venous pressure monitoring. Only a combination of tests gives ample certainty as each test for itself has its pitfalls. After placement of hemodialysis catheters, in particular left-sided catheters, we demand chest X-ray in order to verify that the catheter runs parallel with the long axis of the superior vena cava. In doubtful cases the threshold for contrast-enhanced angiographic control of the catheter should be low. If a perforation by the catheter is suspected it should be ruled out by computed tomographic scanning or transesophageal echocardiography.

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Central Venous Catheters for Maintenance Hemodialysis: A Cautionary Approach

Cited by 10 publications

References 68 publications

Use of a puncture needle for recanalization of an occluded right subclavian vein

Use of a puncture needle for recanalization of an occluded right subclavian vein

Prevention of Hemodialysis Catheter-Related Bloodstream Infection Using an Antimicrobial Lock

Perforation der V. cava superior bei unerkannter Stenose

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