How to deal with dialysis catheters in the ICU setting

Abstract

Acute kidney insufficiency (AKI) occurs frequently in intensive care units (ICU). In the management of vascular access for renal replacement therapy (RRT), several factors need to be taken into consideration to achieve an optimal RRT dose and to limit complications. In the medium and long term, some individuals may become chronic dialysis patients and so preserving the vascular network is of major importance. Few studies have focused on the use of dialysis catheters (DC) in ICUs, and clinical practice is driven by the knowledge and management of long-term dialysis catheter in chronic dialysis patients and of central venous catheter in ICU patients. This review describes the appropriate use and management of DCs required to obtain an accurate RRT dose and to reduce mechanical and infectious complications in the ICU setting. To deliver the best RRT dose, the length and diameter of the catheter need to be sufficient. In patients on intermittent hemodialysis, the right internal jugular insertion is associated with a higher delivered dialysis dose if the prescribed extracorporeal blood flow is higher than 200 ml/min. To prevent DC colonization, the physician has to be vigilant for the jugular position when BMI < 24 and the femoral position when BMI > 28. Subclavian sites should be excluded. Ultrasound guidance should be used especially in jugular sites. Antibiotic-impregnated dialysis catheters and antibiotic locks are not recommended in routine practice. The efficacy of ethanol and citrate locks has yet to be demonstrated. Hygiene procedures must be respected during DC insertion and manipulation.

Risk factors for meticillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis

“…22,23 Also, temporary catheter placement is needed for critically ill patients who require dialysis acutely. 24 MRSA carriage was associated with lower serum albumin levels, similar to the association between hypo-albuminaemia and MRSA colonization in geriatric population. 25 Decreased albumin is frequently caused by poor nutrition, that in turn is linked to increased susceptibility to infection.…”

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

“…Of note, the incidence of CLABSI in this study (5) was Ͼ24 per 1,000 catheter-days and contrasts with the incidence of CRBSI found in the multicenter Cathedia cohort (1.9 per 1,000 catheterdays) (7) and in the study by Skofic et al (8) conducted using the same type of patients (1.6 per 1,000 catheter-days). Whether citrate lock is more effective than saline solution or heparin lock in intensive care unit (ICU) settings and whether it is associated with a lower incidence of CRBSI remain unclear (9).…”

Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?

“…Data on DC dysfunction in the ICU setting are scarce [ 9 , 10 , 17 , 24 ]. Comparison of these studies is difficult because of differences in populations, techniques used for RRT, type of interdialytic DC locks and definitions of dysfunction [ 25 ]. The rates of DC dysfunction observed in our study in the VPI group, both in the main analysis (14 %) and in the second analysis that dealt specifically with patients with serial DC replacements (27.1 %), were in agreement with those published in a study using DC removal to define dysfunction (10 % for first DC placements and 24 % for subsequent placements at a new site) [ 10 ].…”