Risk Factors of Nontunneled Noncuffed Hemodialysis Catheter Malfunction

Hryszko, Tomasz; Brzósko, Szymon; Mazerska, Maria; Małyszko, Jolanta; Myśliwiec, M

doi:10.1159/000076398

Cited by 31 publications

(25 citation statements)

References 8 publications

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“…Catheter dysfunction and URR were not different between sites, possibly because most of the femoral catheters were .20 cm long, in contrast with prior studies (23)(24)(25)(26)(27)(28), and a more central position of the tip reduces dysfunctions and improves the flow by limiting recirculation rates. In addition, all previous studies were observational (23)(24)(25)(26)(27)(28).…”

Section: Discussioncontrasting

confidence: 66%

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Dugué

Levesque²,

Fischer

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Several temporary venous catheterizations are sometimes required for acute renal replacement therapy (RRT) in the intensive care unit (ICU). This study compares first and second catheterizations in the femoral and jugular veins in terms of patient safety.Design, setting, participants, & measurements A crossover study from the catheter-dialysis randomized study (Cathedia), which was conducted among 736 critically ill adults requiring RRT, was performed. Catheter insertion complications, catheter-tip colonization, catheter dysfunction and urea reduction ratio (URR) were analyzed considering the crossover and longitudinal designs.Results This study analyzed 134 patients who underwent two different sites of catheterization, 57 and 77 of whom were initially randomized in the femoral and jugular site, respectively. Using anatomic landmarks, time to insert a femoral catheter was shorter (P=0.01) and more successful (P=0.003) compared with catheterization in the jugular site. Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion (median, 14 days in both groups; hazard ratio, 0.99; 95% confidence interval, 0.61-1.59; P=0.96), as well as time to dysfunction. URRs were analyzed from 395 dialysis sessions (n=48 patients). No significant difference (P=0.49) in mean URR was detected between sessions performed through femoral (n=213; 50.9%) and jugular (n=182; 49.5%) dialysis catheters.Conclusions These results validate prior results of this study group and extend external validity to the second catheter used for RRT in the ICU. Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU.

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Section: Discussioncontrasting

confidence: 66%

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Dugué

Levesque²,

Fischer

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…This is in agreement with previously published data [16]. The explanation for this phenomenon could be the possibility of bending of the catheter localized in the femoral vein.…”

Section: Discussionsupporting

confidence: 93%

Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

et al. 2007

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Background/Aim: Non-tunneled, temporal hemodialysis (HD) catheters are commonly used as short-term vascular access for the HD procedure. One of their late complications is thrombotic occlusion of the catheter ensuing in their malfunction. A heparin lock is conventionally used for maintaining the patency of the catheter. The aim of the study was to evaluate the influence of heparin concentration used for locking the catheter canals (5,000 vs. 2,500 IU/ml) and some other clinical and laboratory variables at the time of temporal HD catheter functioning. Methods: Catheter malfunction was defined as the inability to attain and maintain a blood flow of at least 150 ml/min. 174 consecutive HD catheters inserted into jugular or femoral veins (114 patients) were followed up and remained in use for a total of 3,284 days. Results: Catheter thrombosis occurred in 53 cases (30.5%) during the study period, giving an overall rate of 16 episodes per 1,000 catheter-days at risk. In univariate Cox proportional hazard analysis, predictors of catheter dysfunction were: femoral localization (HR 4.92, 95% CI 4.30–5.50), acute renal failure (HR 1.75, 95% CI 1.18–2.32), higher mean ultrafiltration (UF) (HR 1.31, 95% CI 0.99–1.63) and higher concentration of hemoglobin (HR 1.15, 95% CI 0.99–1.33). The concentration of heparin used for canal locking did not influence the time of catheter functioning (HR 1.1, p = 0.7). In multivariate Cox proportional hazard analysis (χ² = 38.5, d.f. = 4, p < 0.0001) the remaining statistically independent predictors of catheter malfunction were: femoral localization (HR 5.94, 95% CI 5.27–6.61, p < 0.0001) and higher UF (HR 1.60, 95% CI 1.24–1.94, p < 0.01). Conclusions: A lower concentration of heparin (2,500 IU/ml) prevents catheter thrombosis as effectively as a standard one (5,000 IU/ml). Femoral localization of HD catheters and higher UF during the HD procedure are the factors predisposing for catheter malfunction.

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“…Hryszko et al [12] found an independent 5-fold higher risk of catheter dysfunction, defined as inability to maintain blood flow of at least 150 ml/h, with femoral as compared to internal jugular catheters. In that study, however, 75% of patients were fully mobile, and treatment was with intermittent hemodialysis.…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose

Bellomo

Mårtensson

et al. 2015

Blood Purif

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Aims: The study aims to describe the use of dialysis catheters in critically ill patients treated with continuous renal replacement therapy (CRRT) and to study the impact of femoral versus non-femoral access on CRRT dose. Methods: Statistical analysis and predictive modelling of data from the Randomized Evaluation of Normal vs. Augmented Level renal replacement therapy trial. Results: The femoral vein was the first access site in 937 (67%) of 1,399 patients. These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores (p = 0.009) and lower pH (p < 0.001) but similar mortality to patients with non-femoral access (44 vs. 45%; p = 0.63). Lower body weight was independently associated with femoral access placement (OR 0.97, 95% CI 0.96-0.98). Femoral access was associated with a 1.03% lower CRRT dose (p = 0.05), but a 4.20% higher dose was achieved with 13.5 Fr catheters (p = 0.03). Conclusions: Femoral access was preferred in lighter and sicker patients. Catheter gauge had greater impact than catheter site in CRRT dose delivery. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=439581.

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Risk Factors of Nontunneled Noncuffed Hemodialysis Catheter Malfunction

Cited by 31 publications

References 8 publications

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose

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