Temporary central venous catheter at hemodialysis initiation and reasons for use: a cross-sectional study

Abstract

Background Creating permanent vascular access (VA) is recommended before hemodialysis initiation in patients with end-stage renal disease (ESRD). Although many patients are still introduced to hemodialysis with temporary central venous catheters (CVCs), the reasons for their use remain unclear. We aimed to clarify the characteristics of Japanese patients introduced to hemodialysis using temporary CVCs, the reasons for their use, and whether this rate can be reduced in the future. Methods We conducted this cross-sectional study in an acute care general hospital in Japan. We enrolled 393 patients aged ≥ 18 years who received a permanent VA creation for initiating hemodialysis. We classified participants into the temporary CVC group or the permanent VA group according to the VA type at hemodialysis initiation and compared their backgrounds. We identified why permanent VA could not be used at hemodialysis initiation for patients in the temporary CVC group. Results Of the 393 patients, 137 (35%) initiated hemodialysis with a temporary CVC, and arteriovenous fistulas (AVFs) were created as the first VA in all patients during hospitalization following hemodialysis initiation. The remaining 256 patients (65%) initiated hemodialysis via AVF cannulation. The duration of predialysis nephrology care was significantly shorter in the temporary CVC group than that in the permanent VA group. The median time from AVF creation to the first successful cannulation was also shorter in the temporary CVC group (8 vs. 66 days, P < 0.001), but the estimated glomerular filtration rate values at hemodialysis initiation did not differ. Reasons for temporary CVC use were varied and complex. Problems on the part of healthcare providers, patient behavioral issues, and characteristics of causative kidney disease itself were underlying reasons. Delayed referral to a nephrologist was less frequent than expected (16%) and the most commonly reported reason (20%) was that a nephrologist was unable to predict the timing of hemodialysis initiation. Conclusions Patients with ESRD should be referred to a nephrologist earlier for AVF creation. However, given the already relatively high rate of hemodialysis initiation with permanent VA in Japan, we considered it surprisingly difficult to further reduce the temporary CVC usage rate in Japan.

Tunnelled central venous catheters for incident haemodialysis patients: a Victorian survey exploring reasons for use

“…Our survey had several limitations. Data from the Australia and New Zealand Dialysis and Transplant Registry, 6 which reported all new dialysis starts in Victoria in 2020, showed 327 incident HD patients commenced dialysis with T-CVC as their initial dialysis access, with this cohort including both public and private patients. Therefore, although our survey covered only an 8-month period and not the full year and only included patients in public units, our study likely did not capture all patients who commenced HD through a T-CVC in Victoria in the study time period.…”

“…5 In Australia, 58% of patients commenced HD with T-CVCs in 2020. 6 Reasons suggested for the use of T-CVCs are varied, 7 including, but not limited to, clinicians failing to predict the timing of HD initiation, late referral, kidney function deterioration because of other illnesses, patient hesitation and refusal and an AVF not being mature in time.…”

Two cases of aseptic internal jugular vein thrombophlebitis associated with hemodialysis catheter, presenting as sore throat: case report and literature review

“…The use of HD catheters for dialysis initiation should be avoided whenever possible due to the increased length of hospital stay, higher cost, and risk of complications [1]. However, although HD catheters are used less frequently than in the past, they are still frequently used due to lack of patient awareness and unforeseen circumstances [2]. In addition, HD catheters are also mainly used in maintenance dialysis patients as a bridging use until permanent vascular access is created.…”

The effect of single dose prophylactic vancomycin before semi-permanent catheterization to prevent catheter related infection; a randomized controlled trial, phase II

“…Hemodialysis tunneled catheters are easily applicable devices to access the central vein and are commonly used in patients with chronic kidney disease undergoing hemodialysis (2,3). However, insertion of these catheters is followed by several complications including catheter-Introduction: Catheter-related infections are a common complication and a major cause of morbidity and mortality in hemodialysis patients with tunneled central venous catheters.…”