Prospective Evaluation of a Dacron Cuffed Hemodialysis Catheter for Prolonged Use

Schwab, Steve J.; Buller, Gregory L.; McCann, Richard L.; Bollinqer, R. Randal; Stickel, Delford L.

doi:10.1016/s0272-6386(88)80206-3

Cited by 243 publications

(129 citation statements)

References 8 publications

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“…Urokinase was withdrawn from the US market because of a viral contamination but is available in Europe. The published trials have varied in their definition of catheter adequacy after treatment with a thrombolytic agent (minimal acceptable blood flow and duration of benefit) but reported success in 60 and 95% of catheters (97)(98)(99)(100)(101)(102). The benefit is often short-lived, with a median time of 4 wk before requiring another thrombolytic instillation (97,103).…”

Section: Treatment Of Catheter Thrombosis or Malfunctionmentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

244

231

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Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

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Section: Treatment Of Catheter Thrombosis or Malfunctionmentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

244

231

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“…Since their development as an alternative to acute hemodialysis vascular access in the late 1900s, TCCs have generated controversy in the nephrology literature (8,9). TCCs are used as a bridge access device while awaiting maturation of an AVF in patients with severe comorbidities such as congestive heart failure and severe peripheral vascular disease, in the very elderly, in those with inadequate vascular anatomy, in those with limited life expectancy, and as a last resort in patients with multiple access failures (3).…”

Section: The Risks Of Tccsmentioning

confidence: 99%

Ethical and Legal Obligation to Avoid Long-Term Tunneled Catheter Access

Rehman

Schmidt

Moss

2009

Clinical Journal of the American Society of Nephrology

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Despite recent national initiatives promoting the arteriovenous fistula as the initial, primary, and sole vascular access to be used by hemodialysis patients and recommending a decrease in the prevalence of tunneled cuffed catheters to less than 10%, the prevalence of tunneled cuffed catheters as hemodialysis access is increasing. This study describes the risks of tunneled cuffed catheters, explores the reasons why they remain prevalent, and presents the stance that nephrologists have an obligation to offer tunneled cuffed catheters only for temporary use and not as an acceptable alternative for long-term vascular access to patients for whom a properly functioning arteriovenous fistula or graft is possible. Recommendations for tunneled cuffed catheter use were based on dialysis clinical practice guidelines and the medical evidence regarding outcomes of use of arteriovenous fistulas and tunneled cuffed catheters. The authors found that compared with dialysis with arteriovenous fistulas, long-term dialysis with tunneled cuffed catheters is associated with (1) two to threefold increased risk of death, (2) a five to 10-fold increased risk of serious infection, (3) increased hospitalization, (4) a decreased likelihood of adequate dialysis, and (5) an increased number of vascular access procedures. To adequately inform patients about access options, nephrologists are ethically obligated to systematically explain to patients the harms of tunneled cuffed catheters. If catheters must be used to initiate dialysis, nephrologists should present catheters only as "temporary" measures and "unsafe for long-term use."

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“…Initial reports of tunneled, cuffed catheters reported low rates of bacteremia, but these were maintained in patients for a relatively short duration. In our original description, for example, median catheter use was only 8 wk, ranging from 3 wk to 5.4 mo (9). In this early report, only one episode of bacteremia occurred in 80 dual lumen catheters.…”

mentioning

confidence: 78%

The Case Against Chronic Venous Hemodialysis Access

Butterly

Schwab

2002

Journal of the American Society of Nephrology

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The provision of adequate hemodialysis is dependent on repeated and reliable access to the central circulation. This access to the circulation is best provided by primary arteriovenous fistulas (AVF) and to a lesser extent by AV grafts (AVG). AVF have the lowest rates of infection and thrombosis and are therefore the access of choice whenever vascular anatomy allows (1,2). On the other hand, establishing primary AVF in an ever-aging end-stage renal disease (ESRD) patient population with a high prevalence of diabetes and vascular disease has proved a daunting task, at least in the United States. Late referrals to nephrologists make establishment of AVF more difficult. Therefore, our reliance on less desirable modes of vascular access such as synthetic (PTFE) grafts and tunneled, cuffed catheters (CVC) has increased. In fact, up to 60% of new patients and 30% of prevalent patients are using a catheter for dialysis access (3). These latter two accesses are more prone to both thrombosis and infection. Venous access in particular has emerged as a substantial cause of hemodialysis morbidity and mortality. Two articles in this issue of JASN deal with these dilemmas (4,5).Catheter-related bacteremia remains the most common and potentially serious complication of long-term venous access (6 -8). Initial reports of tunneled, cuffed catheters reported low rates of bacteremia, but these were maintained in patients for a relatively short duration. In our original description, for example, median catheter use was only 8 wk, ranging from 3 wk to 5.4 mo (9). In this early report, only one episode of bacteremia occurred in 80 dual lumen catheters. Two more recent studies each showed bacteremia to occur about once every 200 to 250 catheter-days. In the first study, Marr et al. (10) followed 102 patients with CVC for total of 16,081 catheter-days. Bacteremia occurred in this study at a rate of 3.9/1000 catheter-days. Similar to Marr's data, Saad described a mean bacteremia rate of 5.5/1000 catheter-days (11).In our experience, metastatic complications, such as vertebral osteomyelitis, septic arthritis, and endocarditis, have only rarely been seen among our patients in the absence of indwelling catheters. Kovalik et al. (12) demonstrated a significant increase in vertebral osteomyelitis and epidural abscess in patients with dialysis catheters versus AVG. Likewise, Robinson et al. (13) showed that endocarditis occurred at a much higher rate in patients with catheters and was relatively rare in patients using synthetic grafts or AVF. Hence, dialysis with a catheter not only increases the rate of bacteremia but also appears to increase the rate of complications from an individual episode of bacteremia.Furthermore, frequent problems maintaining catheter blood flow in CVC reduce dialysis efficiency and delivered Kt/V. Repeated studies have shown consistently lower delivered dialysis dose with catheters when compared with either grafts or fistulas. For instance, Sehgal et al. (14) demonstrated Kt/V of 1.37 and 1.31 with AVG and AVF, re...

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Prospective Evaluation of a Dacron Cuffed Hemodialysis Catheter for Prolonged Use

Cited by 243 publications

References 8 publications

Current Management of Vascular Access

Current Management of Vascular Access

Ethical and Legal Obligation to Avoid Long-Term Tunneled Catheter Access

The Case Against Chronic Venous Hemodialysis Access

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