Using Tunneled Femoral Vein Catheters for “Urgent Start” Dialysis Patients: A Preliminary Report

Abstract

Femoral vein tunneled catheters appear to be a safe, well tolerated, and effective temporary access in urgent start dialysis patients while they await more appropriate long-term access.

Simulation of Dialysis Access (SoDA) – Eight Stations Hands-On Dialysis Access Simulation

“…Hagen et al investigated whether there is a clinical advantage for one of the catheter types or configurations. They found that comparing straight vs. swan neck and single vs. double-cuffed catheters, no differences were found when results were pooled, confirming the results of the metanalysis by Strippoli et al (4, 5). However, comparison of straight vs. coiled-tip catheters demonstrated that survival was significantly different in favor of straight catheters (hazard ratio 2.05) and that, for surgically inserted catheters, the removal rate and catheter survival at 1 year after insertion were significantly in favor of catheters with a straight intraperitoneal segment (9).…”

“…Thus, if we considered the available “good quality evidence” indeed PD catheter type makes no difference in PD outcomes. Strippoli et al (4, 5) evaluated the use of catheter-related interventions for the prevention of peritonitis in PD. Seventeen trials comparing different catheter insertion techniques, catheter types, use of immobilization techniques or different break in periods were identified.…”

“…No specific minimum number by type of procedure such as dialysis vascular access is prescribed. This becomes important given the DOPPS finding that during training “US surgeons created fewer fistulae (US mean=16 vs. 39-426 in other countries and noted less emphasis on vascular access placement compared with surgeons elsewhere” (5). The authors concluded that “surgical training is key to both fistula placement and survival” (5).…”

Urgent Peritoneal Dialysis or Hemodialysis Catheter Dialysis

“…Dialysis access has also been proven less costly in the first 3 months with urgent peritoneal dialysis (US$16,000 total with dialysis access representing 15% of costs) than urgent hemodialysis (US$19,000 total with dialysis access representing 27% of costs). If hemodialysis is chosen, the duration of CVC exposure should be limited and all efforts should be made to avoid the central veins, including the use of tunnelled femoral catheters and early cannulation grafts; however, this again, depends on the individual's situation (29). In special circumstances (listed above), the appropriate dialysis and access is hemodialysis via a CVC.…”

Validity of administrative database code algorithms to identify vascular access placement, surgical revisions, and secondary patency

“…We have previously used this database for research purposes. [5][6][7][8] Three linked administrative data sources (Ontario Health Insurance Plan (OHIP), Discharge Abstract Database (DAD), and Registered Persons Database (RPDB)) were used to identify type of vascular access placement, secondary patency, AV access surgical revisions, patient demographics, and comorbidities. We have previously used these databases to study vascular access and hemodialysis initiation outcomes.…”