Radiological placement of the AshSplit haemodialysis catheter: a prospective analysis of outcome and complications

Ewing, Fiona; Patel, Dilip Kumar; Petherick, Anne; Winney, R. J.; McBride, Katharine

doi:10.1093/ndt/17.4.614

Cited by 29 publications

(21 citation statements)

References 13 publications

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“…Mean AshSplit catheter duration (246 days) is similar to Permcath (239 days) in our group, but is longer than previously reported, 190 days for AshSplit, [2] 105 days for Permcath, [4] and 199 days for Tesio catheters. [12] As some of our catheters still functioned after 1,278 days, they could be considered as permanent vascular access, and therefore, our catheter dwell times are approaching that of the gold standard native AVF.…”

Section: Discussionsupporting

confidence: 76%

“…This fact stresses the importance of maintaining a safe and effective method of insertion, with few complications. Insertion complications experienced for AshSplit (6%) and Permcath (6%) in our study group are lower than previously reported by Ewing et al (11.8% AshSplit) [2] and Perini et al (Tesio 9%), [11] with only one patient requiring further intervention as a result of a complication (0.5% overall).…”

Section: Discussioncontrasting

confidence: 60%

“…Currently, the three forms of longterm access most commonly used are the native (BresciaCimino) fistula, the synthetic graft, and the tunneled cuffed catheter. The surgically created arterio-venous fistula (AVF) is the vascular access route of choice for hemodialysis [2,3] ; however, short-or long-term alternative access routes are often needed. [4] Tunneled hemodialysis 722 A.N.…”

Section: Introductionmentioning

confidence: 99%

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Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

et al. 2007

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Background. Recently, interventional radiologists have adopted an increasingly prominent role in the placement and management of hemodialysis catheters, as well as in the research and development of new and better catheters. The purpose of this study was to evaluate the viability and hemodialysis efficiency of the AshSplit catheter and the Permcath catheter. Methods. 204 consecutive patients requiring radiological insertion of hemodialysis catheters were followed, retrospectively, over a 42-month period. Both hemodialysis catheters were placed using a combination of ultrasonic and fluoroscopic guidance and tunneled appropriately. Information collected included catheter insertion sites, insertion complications, catheter duration, and final outcome. Results. Over the study period of two years, 269 catheters were placed into 204 patients with end stage renal failure. Patients received either an AshSplit (101 patients, 127 catheters) or a Permcath (103 patients, 142 catheters). Vascular access route of choice was the right internal jugular vein (67% AshSplit, 71% Permcath). Insertion complications occurred in 18 patients overall (6.6%), with only 1 requiring further intervention (hemopneumothorax). Flow rates averaged 259 mls/min for AshSplits and 248 mls/min for Permcaths (p < 0.001). Follow-up of catheter viability for 42 months yielded a mean AshSplit catheter duration of 246 days (range 6-932) and 239 days (range 1-1,278) for Permcath (p = 0.46). Reasons for catheter failure and elective catheter removal were similar in both groups; however, Permcaths required significantly more thrombolysis than AshSplits, p < 0.001. Conclusion. The AshSplit provides significantly better flow rates and less thrombolysis compared to the Permcath, with similar catheter dwell times.

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Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

et al. 2007

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“…This meta-analysis of internal jugular TDC-related bacteremia rates was based on data published in 15 articles that met the following criteria: prospective studies, including prospective cohort and randomized controlled trials of tunneled, cuffed catheters with at least 20 patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Studies of the LifeSite Hemodialysis Access System (Vasca Inc, Tewksbury, Mass) and Dialock Access System (Biolink Inc, Norwell, Mass) were excluded. The final normalized cumulative TDC bacteremia control rate was 2.3/1000 catheter days.…”

Section: Methodsmentioning

confidence: 99%

Initial experience and outcome of a new hemodialysis access device for catheter-dependent patients

Katzman

McLafferty

Ross

et al. 2009

Journal of Vascular Surgery

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“…Catheter dysfunction has been defined by Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines as "failure to maintain an extracorporeal blood flow sufficient to perform hemodialysis without significantly lengthening the hemodialysis treatment" (4). The guidelines and many research studies set a minimum blood flow target of 300 ml/min (5)(6)(7)(8)(9)(10)(11). Using this target, between 55 and 87% of catheters will experience dysfunction at least once (6,12), and 5 to 13% will require catheter replacement to treat dysfunction that is refractory to other measures such as patient repositioning, saline flushes, lumen reversal, and thrombolytic dwells (9 -11,13,14).…”

mentioning

confidence: 99%

Catheter Patency and Function after Catheter Sheath Disruption

Oliver

Mendelssohn

Quinn

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hemodialysis catheters are frequently complicated by dysfunction from fibrin sheaths. Previous studies of sheath disruption have methodologic limitations but suggest that the patency after disruption is short.Design, setting, participants, & measurements: A randomized, controlled, pilot trial was conducted to investigate the impact of angioplasty sheath disruption on catheter patency and function. Forty-seven long-term hemodialysis patients with secondary, refractory catheter dysfunction underwent guidewire exchange to replace their catheters.Results: Sheaths were present in 33 (70%) of the 47 patients. In 18 patients who were randomly assigned to disruption, the median time to repeat dysfunction was 373 d compared with 97.5 d in patients who did not undergo disruption (P ‫؍‬ 0.22), and the median time to repeat catheter exchange was 411 and 198 d, respectively (P ‫؍‬ 0.17). Mean blood flow (340 versus 329 ml/min; P < 0.001) and urea reduction ratio (72 versus 66%; P < 0.001) were higher in the disruption group. Fourteen patients had no sheaths, and their median times to repeat dysfunction and repeat exchange were 849 and 879 d, respectively. Patients with no sheaths had higher urea reduction ratio (73 versus 66%; P < 0.001) and a lower percentage of inadequate hemodialysis treatments (9.8 versus 27%; P ‫؍‬ 0.01) and treatments that required thrombolytics (1.8 versus 5.0%; P ‫؍‬ 0.03) than patients with sheaths that were not disrupted.Conclusions: Disrupting sheaths by angioplasty balloon results in durable catheter patency and modestly improves blood flow and clearance over the duration of catheter use.

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Radiological placement of the AshSplit haemodialysis catheter: a prospective analysis of outcome and complications

Abstract: Radiological insertion of the AshSplit catheter is well tolerated, providing reliable short- and long-term dialysis access. Radiology also has a role in maintaining patency. As with all tunnelled catheters, infection remains a problem.

Cited by 29 publications

References 13 publications

Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

Initial experience and outcome of a new hemodialysis access device for catheter-dependent patients

Catheter Patency and Function after Catheter Sheath Disruption

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