How Can the Complications of Central Vein Catheters Be Reduced?

Toomay, Seth; Rectenwald, John E.; Vázquez, Miguel A.

doi:10.1111/sdi.12478

Cited by 14 publications

(8 citation statements)

References 18 publications

(48 reference statements)

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“…Although its true incidence is unknown (64), it is an important consideration, because the majority of patients on HD initiate dialysis with a CVC. The presence of central venous stenosis/occlusion may prohibit the creation of an AV access (65); an ipsilateral access will likely result in upper extremity edema and/or early AV access failure (66).…”

Section: Central Venous Stenosismentioning

confidence: 99%

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Woo

2016

CJASN

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Optimal vascular access planning begins when the patient is in the predialysis stages of CKD. The choice of optimal vascular access for an individual patient and determining timing of access creation are dependent on a multitude of factors that can vary widely with each patient, including demographics, comorbidities, anatomy, and personal preferences. It is important to consider every patient's ESRD life plan (hence, their overall dialysis access life plan for every vascular access creation or placement). Optimal access type and timing of access creation are also influenced by factors external to the patient, such as surgeon experience and processes of care. In this review, we will discuss the key determinants in optimal access type and timing of access creation for upper extremity arteriovenous fistulas and grafts.

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Section: Central Venous Stenosismentioning

confidence: 99%

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Woo

2016

CJASN

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“…The cause of this was mostly due to central vein stenosis that was not revealed by DUS screening. Subclavian catheters have been reported to cause these lesions in up to 50% of cases 47,48 Five patients improved with conservative methods, mostly due to dilatation of the developed collateral and low grade of stenosis in them.…”

Section: Discussionmentioning

confidence: 99%

Long-term Patency of Arteriovenous Fistulas as a Vascular Access in Paediatric Age Group Patients with End-stage Renal Disease-Egyptian experience

Lotfy

Shaalan

Elemam

et al. 2021

Ain Shams Journal of Surgery

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Background: Vascular access (VA) for hemodialysis (HD) is the cornerstone of treatment of end-stage renal disease in children. Purpose:To evaluate the causes that may result in primary failures, to evaluate the long-term outcome of AVFs in the vascular access as regards primary and secondary access patency, and to study the effect of patients' demographics and type of VA upon patency.Patients and methods: Paediatric age group patients with ESRD from El Shatby University Hospital for Children were evaluated by duplex ultrasound and VA was constructed.Results: 218 children were evaluated.188 children had AVF. The initial success rate was 96.8%. Early failure occurred in 13.9%. The mean follow-up was 18.9 ± 11.2 months. 75% of our patients were blow 50th percentile. The mean maturation-time was 1.7±0.5 months. Primary and secondary patency rates at 1, 2, and 3 years of follow-up, were 80.1% (± 2%), 67.3% (±2%), 41.3% (±2%), and 85.4% (±1%), 75.6% (± 1%), and 67.4% (± 1%) respectively. Complications were stenosis, thrombosis, infection, venous hypertension, steal, aneurysms and pseudoaneurysm, and high-flow AVF. At the end of the follow-up period, 32 (17.3%) AVFs were complicated and eventually failed, 20 (10.8%) were abandoned due to death or patients lost follow-up, and 125 (67%) were patent. Conclusion:AVFs in paediatric age group have a good outcome and long-term patency provided by good choice of the patient, and operation by dedicated surgeons. Surveillance of the fistula and rapid correction of any complications are very crucial steps to keep the fistula functioning.

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“…CVC use has been shown to be associated with high infection rates, [5][6][7] rehospitalization, 8,9 and increased venous stenosis thereby affecting future dialysis access. 3,4 CVC use has also been shown to be more costly. 5,[10][11][12] However, the relationship of CVC use to mortality is more complicated.…”

Section: Discussionmentioning

confidence: 99%

“…Among Medicare-eligible patients, 78.3% initiated hemodialysis on a CVC, and at 90 days, 66.1% continued to use a CVC. 1 Although the increased risks (central venous stenosis, 3,4 infection, [5][6][7] hospitalization, 8,9 and mortality 5,[9][10][11] ) and costs 5,[10][11][12] associated with CVC compared with AVF are well known, less is known about the natural history of CVC use. 5,13,14 Previous studies have shown that nonwhite patients tend to initiate hemodialysis with AVF less frequently than white patients and men, despite controlling for factors such as age, comorbidities, medical insurance status, and nephrology care.…”

mentioning

confidence: 99%

Racial and Sex Disparities in Catheter Use and Dialysis Access in the United States Medicare Population

Arya

Melanson

George³

et al. 2020

JASN

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BackgroundDespite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC).MethodsTo better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013.ResultsAt 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft.ConclusionsFemale patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

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How Can the Complications of Central Vein Catheters Be Reduced?

Cited by 14 publications

References 18 publications

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Long-term Patency of Arteriovenous Fistulas as a Vascular Access in Paediatric Age Group Patients with End-stage Renal Disease-Egyptian experience

Racial and Sex Disparities in Catheter Use and Dialysis Access in the United States Medicare Population

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