Randomized Study of Temporary Hemodialysis Catheters

Oliver, Matthew J.; Edwards, Lloyd J.; Treleaven, Darin; Lambert, Katy; Margetts, Peter J.

doi:10.1177/039139880202500107

Cited by 43 publications

(30 citation statements)

References 17 publications

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“…Sheath disruption seems safe with no increase in postprocedure symptoms compared with guidewire exchange without disruption. Left-sided internal jugular placement and reversal of catheters independently reduced catheter function, in agreement with other studies (5,25,27). Fibrin sheaths were first described by Hoshal et al (21).…”

Section: Discussionsupporting

confidence: 92%

“…The radiologist randomly assigned patients with sheaths by opening opaque envelopes in the radiology suite. The randomization schedule was stratified by center and by side of catheter (left-sided catheters are at higher risk for dysfunction [25]) using a block-of-four design. Radiologists were instructed to try to maintain blinding during the procedure by not informing patients of the presence of sheaths or disruption.…”

Section: Concise Methodsmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 92%

Section: Concise Methodsmentioning

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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“…Surprisingly, despite the importance of this clinical problem, there are only few reports which identify factors influencing temporary HC survival. Left-sided internal jugular catheters, female sex [6]and ESRD [7]were found to be associated with HC malfunction. It is thought, that HC placed in femoral vein are more prone to a malfunction comparing to catheters inserted in the subclavian or internal jugular vein.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Nontunneled Noncuffed Hemodialysis Catheter Malfunction

et al. 2004

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Background: The use of noncuffed nontunneled central venous catheters is a widely accepted method of gaining temporary vascular access for hemodialysis. Malfunction and bacteremia are the main factors limiting catheter survival. Methods: We followed up prospectively 73 hemodialysis catheters (HC) (40 internal jugular, 33 femoral) in order to establish factors influencing HC malfunction. HC malfunction was defined as a catheter that was unable to attain and maintain blood flows of at least 150 ml/min. 73 HC were used for a total 1,100 days. Results: HC malfunction occurred in 23 cases (31.51%) during the study period, giving an overall rate of 21 episodes per 1,000 catheter days at risk. An analysis revealed a higher risk of HC malfunction with the catheterization of the femoral vein compared to the internal jugular vein (hazard ratio (HR) 6.3; 95% confidence interval (CI) 5.3–7.3). After correction for confounding factors in multivariate Cox analysis, the site of the catheterization remained a statistically significant predictor of HC malfunction (HR 5.03, 95% CI 3.83–6.23). After the first week malfunction rate was 42 and 8% for femoral and internal jugular site, respectively (relative risk (RR) for malfunction 5.3 (95% CI, 2.5–8). After the second and third week, the incidence of malfunction was 51 and 14% for femoral and internal jugular vein, respectively (RR 3.6, 95% CI 2.2–5.1). Conclusions: Catheterization of the internal jugular vein is associated with longer catheter survival when compared to the femoral vein. Hemodialysis catheters should be placed, if possible, in internal jugular vein to prevent their premature malfunction.

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“…The KDIGO Clinical Practice Guideline for Acute Kidney Injury recommend the right jugular vein as the most optimal site for catheter placement, followed by the femoral veins, left internal jugular vein, and lastly the subclavian veins, with preference for placement on the dominant side [40]. The preference for the right internal jugular vein is based on lower rates of catheter dysfunction based on venous anatomy as compared to the left internal jugular vein [41]. There is a general preference for catheters above the waist as compared to catheters in the femoral veins due to increased risk of infection; however, in a randomized trial of 750 patients requiring dialysis for AKI the incidence of catheterrelated blood stream infection was not higher in patients with femoral catheters [42].…”

Section: Vascular Accessmentioning

confidence: 99%