Survival of tunneled hemodialysis catheters after percutaneous placement.

Weber, Ewa; Liberek, Tomasz; Wołyniec, Wojciech; Gruszecki, Marcin; Rutkowski, Bolesław

doi:10.18388/abp.2015_1111

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Death with a working TCC was the most common cause of catheter drop-out, as reported previously. [ 9 13 ] About 31% of patients died during follow-up. Previous cohorts have reported 2-3 times increased deaths in patients on catheters.…”

Section: Discussionmentioning

confidence: 99%

Dialysis vascular access: Where do tunneled catheters stand? – A single-center experience

et al. 2021

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Introduction: Tunneled cuffed catheters (TCC) provides a short and intermediate-term access solution for dialysis patients who fail to get an arteriovenous fistula (AVF). They are associated with high morbidity and mortality along with high rates of infectious complications. Methods: We present a single-center prospective cohort of 159 TCCs inserted over one year. Patients were dialyzed in-hospital and in various peripheral dialysis units attached to the institute. The primary endpoint was catheter drop-out. Results: The mean age of patients was 41.8 ± 16.9 years. The right internal jugular vein was the commonest site of TCC insertion (66%). The absence of suitable veins was the predominant reason for TCC insertion. The mean time to catheter drop-out was 134.4 ± 83.3 days (5–399 days). Death with a working catheter was the most common cause of catheter drop-out (22.6%). About 25% of catheters were lost to catheter-related bloodstream infections (CRBSI), either alone or as overlap with poor flow. CRBSI rates were 3.74 episodes per 1000 catheter-days. No difference in survival between the staggered tip and split-tip catheters was found. Conclusions: With the advent of the “hub and spoke” model for dialysis in the public sector healthcare, TCCs are suboptimal with regards to patient and catheter survival, with high infection rates. It must be regarded as a temporary solution and AVF creation should be prioritized.

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Section: Discussionmentioning

confidence: 99%

Dialysis vascular access: Where do tunneled catheters stand? – A single-center experience

et al. 2021

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“…[7][8][9][10] In the present study the mean catheter-related infection rate was rather low at 0.18/100 catheter-days, while previously reported infection rates have varied from 0.14-0.52 episodes/100 catheter days. [11][12][13] Nonetheless, catheter related infection, especially when FV access was used, still remained the main reason for catheter removal and were a significant risk factor for catheter failure. Catheter malposition was observed more frequently when using the left IJV and transhepatic access, similar to previous reports.…”

Section: Discussionmentioning

confidence: 99%

Farklı Vasküler Giriş Yollarında Tünelli Hemodiyaliz Kateterlerinin Değerlendirilmesi

Çam

Genez²,

Şengül³

et al. 2021

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi

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Objective: To determine the patency rates and reasons for failure using different access routes for tunneled hemodialysis catheters. Methods: The records of patients who underwent insertion of 14 French tunnelled hemodialysis catheters were retrospectively analyzed. Catheter patency survival was demonstrated using Kaplan-Meier survival curve. Catheter failure and exchange reasons were evaluated. Results: One hundred and six patients underwent 474 catheter exchanges (mean/patient 4.47±1.62). Access was via right internal jugular vein (IJV) n=40, left IJV n=23, right femoral vein (FV) n=18, left FV n=11 and transhepatic vein n=14. The causes of catheter failure and exchange were: catheter-associated infection, catheter thrombosis, fibrin sheath and catheter tip malposition. Mean primary and cumulative catheter patency time (721 and 1276 days, respectively) was higher in the right IJV group compared with the others (p<0.001). The same parameters were lowest in the transhepatic group, being 118 and 466 days, for primary and cumulative patency, respectively (p<0.001). The incidence of catheter-related infections was higher in the left FV (0.42/100 patient-days) and catheter tip malposition was higher in the transhepatic (0.38/100 patient-days) and in the left IJV (0.32/100 patient-days). Conclusion:The use of right IJV should be the first option for hemodialysis access route. Based on our findings, if right IJV is unavailable the optimal access routes in order would be left IJV, right FV, left FV and finally transhepatic vein.

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“…It is important to distinguish between catheter loss due to dysfunction, thrombosis, or infection vs elective catheter removal due to renal recovery, modality change, or transplant. A recent single‐center study showed that only 10.5% of catheters required removal due to complications in the first 3.5 years . When censored for elective catheter removal and death with a functioning catheter, 1‐year catheter survival was 88%.…”

Section: Vascular Access Should Be Reliable and Durablementioning

confidence: 99%

Central venous catheters for chronic hemodialysis: Is “last choice” never the “right choice”?

Dumaine

Brown

MacRae

et al. 2017

Seminars in Dialysis

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Since the publication of the first vascular access clinical practice guidelines in 1997, the global nephrology community has dedicated significant time and resources toward increasing the prevalence of arteriovenous fistulas and decreasing the prevalence of central venous catheters for hemodialysis. These efforts have been bolstered by observational studies showing an association between catheter use and increased patient morbidity and mortality. To date, however, no randomized comparisons of the outcomes of different forms of vascular access have been conducted. There is mounting evidence that much of the difference in patient outcomes may be explained by patient factors, rather than choice of vascular access.Some have called into question the appropriateness of fistula creation for certain patient populations, such as those with limited life expectancy and those at high risk of fistula-related complications. In this review, we explore the extent to which catheters and fistulas exhibit the characteristics of the "ideal" vascular access and highlight the significant knowledge gaps that exist in the current literature.Further studies, ideally randomized comparisons of different forms of vascular access, are required to better inform shared decision making.Twenty years ago, fistulas were first promoted as the vascular access of choice by the Kidney Disease Outcomes Quality Initiative.1 Since then, the nephrology community has worked to increase fistula prevalence and reduce the use of central venous catheters. These efforts have been supported by initiatives such as Fistula First, 2 clinical practice guidelines from around the world, [3][4][5][6] and in some jurisdictions, by financial incentives which reward dialysis centers with high fistula prevalence and penalize those with high catheter prevalence. 7 In 2007, a modification of the Fistula First Initiative to "Fistula First, Catheter Last" was proposed, re-emphasizing the perceived importance of minimizing catheter use. 8 However, critics of "Fistula First, Catheter Last" have expressed concern that all comparisons between access types have been observational, subject to high degrees of bias, 9,10 and unable to account for other patient factors which likely contribute to poor outcomes seen in patients treated with catheters. 11,12 Others have questioned the utility of fistula creation in elderly patients and in patients at high risk for fistula failure or complications, arguing that such patients may be better served by catheters. 13 Surveys of the nephrology community suggest that many clinicians feel that a catheter is often appropriate and that there is equipoise regarding the ideal form of vascular access in many situations. 14,15 In fact, enrollment recently began for a pilot randomized trial comparing outcomes in incident hemodialysis patients, over the age of 65, who start dialysis with a catheter. Patients will be randomized to creation of a fistula vs continued use of a catheter (clinicaltrials.gov NCT02675569). 16The ideal vascular access has...

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Survival of tunneled hemodialysis catheters after percutaneous placement.

Cited by 11 publications

References 24 publications

Dialysis vascular access: Where do tunneled catheters stand? – A single-center experience

Dialysis vascular access: Where do tunneled catheters stand? – A single-center experience

Farklı Vasküler Giriş Yollarında Tünelli Hemodiyaliz Kateterlerinin Değerlendirilmesi

Central venous catheters for chronic hemodialysis: Is “last choice” never the “right choice”?

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