Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study

Griffiths, Robert I.; Newsome, Britt B.; Leung, Grace; Block, Geoffrey A.; Herbert, Robert J.; Danese, Mark D.

doi:10.1155/2012/673954

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…Central tunnelled catheter dysfunction is the leading non-infectious complication causing the patient's inability to obtain an effective dialysis treatment 18 . The non-invasive tunnelled catheter tip reposition (NTCR) manoeuvre presented in this paper may offer the dialysis staff an additional cost-effective tool to restore CTC function before the administration of fibrinolytic agents.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis

Porażko

Hobot

Klinger

2020

Sci Rep

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Despite all efforts, still many end-stage kidney disease (ESKD) patients are dialysed using a central tunnelled catheter (CTC) as vascular access. When the CTC blood flow becomes ineffective, a number of protocols are advised. However, all of them are time-and cost-consuming. The manoeuvre of a noninvasive tunnelled catheter reposition (NTCR) was introduced to restore the CTC function. NTCR was based on gentle movements of the CTC, with or without a simultaneous flushing of the CTC lines, which resulted in a quick reposition of the CTC tip. This study comprises the analysis of a total of 297 NTCRs, which were performed in 114 patients, thus enabling an effective blood flow after 133 procedures (44.7%).Partially effective blood flow followed 123 procedures (41.4%), and it failed altogether in 41 cases (13.9%). Overall, 86% of conducted NTCRs improved the CTC patency to perform a haemodialysis session. The procedure could be successfully repeated, with a similar result after the first and the second attempt. Complications were observed only after 3.4% of all interventions. The novel NTCR manoeuvre was safe and effective in the majority of the CTC dysfunction episodes. It seemed to reduce fibrinolytic usage, allowed an immediate haemodialysis session commencement, therefore, it might save both the costs and the nursing staff time. According to registries data, CTCs were used in 68% of the incident and 32% of the prevalent haemodialysis patients in Europe 1. The 2018 Annual Data Report of the United States Renal Data System (USRDS) showed that over 80% of the US patients started haemodialysis with a CTC, and in 69% of them the catheter was still in use after 90 days 2. After comparing dialysis patients from 20 countries, catheter usage ranged from 1% in Japan to 45% in Canada 3. CTC dysfunction was a leading non-infectious complication of this type of vascular access for haemodialysis 4,5. The recent Canadian Observational Study reported one year and two year episodes, in which CTC dysfunction occurred in 15% and 18% of patients, respectively 6. It was generally defined as a failure to aspirate the locking solution from the CTC lines, blood flow rate (QB) through the lines of less than 300 ml/min., arterial pressure of less than 250 mmHg, high venous pressure greater than 250 mmHg, as well as the necessity for the CTC lines reversal 7-9. When this complication occurs repeatedly, it may lead to an ineffectiveness of renal replacement therapy (RRT) with low urea clearance (Kt/V < 1.2 or urea reduction ratio <65%) 7-9. A number of conservative measures and medical management protocols were established to solve the problem. Firstly, it is advised to flush the CTC lines with normal saline solution, place the patient in the Trendelenburg position, on a patient's sides or adjustment of a head position, and finally one can connect the CTC lines in a reversed way 7,8. However, repeated attempts, sometimes performed in an inappropriate way, increase the risk of complications, i.e. the CTC damage or a catheter-related infection...

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Section: Discussionmentioning

confidence: 99%

Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis

Porażko

Hobot

Klinger

2020

Sci Rep

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“…Written informed consent was obtained from all participants prior to examination. From April 2014 to August 2015, all patients with CDC transjugular access and suspicion of catheter dysfunction (failure to attain a sufficient extracorporeal blood flow of ≥300 mL/min with a prepump arterial pressure more negative than −250 mm Hg for 2 weeks) [ 3 , 12 ] were consecutively recruited and underwent MRI and chest x-ray in our study.…”

Section: Methodsmentioning

confidence: 99%

“…[ 1 ] However, for those patients who are not a good candidate for an arteriovenous fistula or those who require dialysis during maturation of the arteriovenous fistula, establishing an effective vessel access through the internal jugular vein is the best choice, with easy visualization of the jugular vein by ultrasound and direct connection to the superior vena cava and right atrium [ 2 ] that is adequate to meet the dialysis requirement with the use a catheter of at least of 300cc per minute. [ 1 , 3 ] In the United States, over 60% of patients begin hemodialysis with placement of transjugular chronic dialysis catheter (CDC). [ 4 ] In China, the number of patients receiving CDC hemodialysis increases.…”

Section: Introductionmentioning

confidence: 99%

Thrombotic complications and tip position of transjugular chronic dialysis catheter scheduled into superior vena cava

Wang

et al. 2017

Medicine

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Background:Catheter-related thrombotic complications(TCs) can occur during the long term use of a chronic dialysis catheter (CDC), including fibrin sheath (FS), mural thrombosis (MT), venous thrombosis (VT), and intraluminal clots (IC), which has not been reported with MRI. The aim of our study was to evaluate the determination of catheter tip position (TP) and resolution of TCs in patients with transjugular CDC scheduled into the superior vena cava using high resolution magnetic resonance cholangiopancreatography (HR-MRCP) and T2-weighted imaging (HR-T2WI).Methods:The study protocol was approved by the local Research Ethics Committee. Informed consent was obtained from all patients. In total, 41 consecutively enrolled transjugular CDC patients with suspected catheter dysfunction were scanned with HRMRCP and HR-T2WI. The distance from the top to the tip of the catheter and the presence and nature of catheter TCs were assessed by 2 experienced radiologists. Chest x-ray was taken within 1 to 2 days and CDC was withdrawn within 3 to 10 days from those patients with TCs identified by HR-MRI.Results:A total of 38 subjects successfully underwent HR-MRI, including 13 normal and 25 with TCs (fibrin sheath [FS]: n = 21, mural thrombosis [MT]: n = 7, venous thrombosis [VT]: n = 3, intraluminal clots [IC]: n = 4). There was no significant difference between HR-MRCP and chest x-ray in catheter TP determination (P = .124). Normal catheter appeared as “double eyes” on HR-T2WI and “double tracks” on HR-MRCP. TCs appeared as follows: FS displayed as a “thin ring” (<1mm) around the catheter, MT as patchy hyperintensity and VT as a “thick ring” (>5mm) on HR-T2WI. Unilateral IC appeared as a “single eye” on HR-T2WI and a “single track” on HR-MRCP (n = 3). Bilateral IC appeared as neither “eye” nor “track” (n = 1). Catheter withdrawal confirmed FS (n = 16), MT (n = 6), VT (n = 1), and IC (n = 4).Conclusion:HR-MRCP and HR-T2WI are promising methods for visualizing TP and TCs in CDC patients, and are helpful in adjusting the treatment plan and avoiding the risk of pulmonary embolism.

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“…Consequences include disruption in the delivery of dialysis care and increase in health resource utilization. 7 …”

Section: Catheter Dysfunctionmentioning

confidence: 99%

Hemodialysis Tunneled Catheter Noninfectious Complications

Miller

MacRae

Kiaii

et al. 2016

Can J Kidney Health Dis

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Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.

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Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study

Cited by 11 publications

References 15 publications

Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis

Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis

Thrombotic complications and tip position of transjugular chronic dialysis catheter scheduled into superior vena cava

Hemodialysis Tunneled Catheter Noninfectious Complications

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