A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters†

Little, Mark A.; O'Riordan, Aisling; Lucey, Brian C.; Farrell, Michael; Lee, Michael; Conlon, Peter J.; Walshe, J. Joseph

doi:10.1093/ndt/16.11.2194

Cited by 136 publications

(123 citation statements)

References 16 publications

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“…14 It is estimated that catheter dysfunction accounts for 17-33% of untimely catheter removals. 24,25 Therefore, the lower incidence rate of low blood flow observed with symmetricaltip versus step-tip catheters in this study may be a contributing factor to the significantly longer mean dwell time associated with this catheter design. It has been proposed that because blood enters the symmetrical-tip catheter through the side slots and exits through the tip, this reduces the formation of thrombus and fibrin sheath formation, leading to a lower rate of fibrin sheath formation with the spiral-tip design of the symmetrical-tip catheter (8.7%), compared with other catheter types (42-100%).…”

Section: Symmetrical-tip N ¼ 118mentioning

confidence: 78%

A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China

Mao

Zhang

et al. 2015

Renal Failure

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Hemodialysis catheters remain necessary for long-term vascular access in patients for whom arteriovenous access may be problematic or impossible. Developments in catheter design have improved long-term catheter functionality, and reduced the rate of infection and complications associated with their use. This retrospective study of 284 cases of chronic catheterization in 271 patients treated between 2009 and 2011 using Tal Palindromeä symmetrical-tip (N ¼ 118) or Quintonä Permcathä step-tip (N ¼ 166) hemodialysis catheters evaluates the efficacy and the safety of symmetrical-tip dialysis catheters for chronic hemodialysis, compared with a step-tip catheter. Measurements of catheter performance included mean catheter dwell time, incidence of low blood flow, and rates of infection and catheter-related blood stream infection (CRBSI). The symmetrical-tip catheter had a significantly longer mean dwell time compared with the step-tip catheter; 329.4 ± 38.1 versus 273.1 ± 25.4 d (p50.05). In addition, the rate of occurrence of low blood flow per 1000 catheter days was lower for the symmetrical-tip compared with the step-tip catheter; 1.13 versus 6.86 (p50.01). The symmetrical-tip catheter was also associated with a lower incidence of complications; the rates of infection (0.28 vs. 0.78; p50.01) and CRBSI (0.15 vs. 0.44; p50.01) were lower compared with those for step-tip catheters, and catheter removal occurred less often for the symmetrical-tip catheter (8% vs. 16%; p50.05). The symmetrical-tip hemodialysis catheter was associated with a longer mean dwell time, lower incidence of low blood flow, and lower infection rate compared with the step-tip catheter.

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Section: Symmetrical-tip N ¼ 118mentioning

confidence: 78%

A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China

Mao

Zhang

et al. 2015

Renal Failure

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“…Episodes were regarded as "Possible" CRBSI when pyrexia resolved after removal of catheter with or without antibiotic treatment in the absence of laboratory confirmation of bloodstream infection in a symptomatic patient with no other apparent source of infection 51,52 .…”

Section: Diagnosis Of Intravascular Catheter-related Bloodstream Infementioning

confidence: 99%

Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial

Kanaa

Wright

Akbani

et al. 2015

American Journal of Kidney Diseases

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BackgroundCatheter-related bloodstream infections (CRBSI) are associated with increased morbidity and mortality in hemodialysis patients (HD). Cathasept (Tetra-sodium EDTA) solution has antimicrobial and anticoagulant activities. Study DesignMulti-center, prospective, randomized, and controlled study. Setting & Participants117 maintenance HD patients with confirmed uncolonised tunneled hemodialysis catheters (t-HDC) were recruited from four hemodialysis centers. InterventionPatients were randomly assigned to remain on heparin 5000 units/ml locks (Heparin Group -HG) or to receive Cathasept 4% locks (Cathasept Group -CG) thrice weekly according to the catheter lumen volume and were followed up until their catheter was removed or for a maximum of 8 months. OutcomesPrimary outcome was the incidence rate of clinically significant microbial colonization of t-HDC defined as through-catheter quantitative blood culture (TCQBC) yielding ≥1000 CFU/ml of bacteria or yeast. Secondary outcomes included CRBSI rate, catheter patency, and biomarkers of inflammation and anemia. MeasurementsWeekly TCQBC. hs-CRP was measured fortnightly, and FBC and Ferritin monthly. ResultsCatheter colonization rate was 0.14/1000 catheter-days in the CG and 1.08/1000 catheter-days in the HG [Incidence rate ratio (IRR) 0.13; 95% CI, 0.003-0.94; p=0.02]. CRBSI rate was 0.28/1000 catheter-days in the CG and 0.68/1000 catheter 4 days in the HG [IRR 0.40; 95% CI, p=0.3]. The proportion of dialysis sessions with achieved prescribed blood flow rate was significantly lower in the CG (66.8% vs 75.3%; p<0.001), with more patients required thrombolytic locks or infusion to maintain catheter patency (22 vs 9; p=0.01). On average, hs-CRP was 11.6 (SE ±5.3) mg/l lower for patients in the HG (p=0.03). Anemia markers were comparable in both groups. LimitationsThe study was underpowered to assess the effect on CRBSI, was terminated early due to slow recruitment, and was not double-blinded. ConclusionCathasept significantly reduced t-HDC colonization but the reduction in CRBSI was not statistically significant, and it was associated with more thrombotic complications.Its safety profile was comparable to heparin lock solution.

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“…8,9 Given these adverse outcomes and high costs, further research on strategies to optimize the use of hemodialysis catheters is required, particularly with regard to preventing the most common adverse catheter outcomes of malfunction (i.e., inability to initiate or continue dialysis because of to inadequate bloodflow, often the result of catheter thrombosis) and bacteremia. 5,6 Heparin has traditionally been used as an intradialytic catheter locking solution, although other agents are now used, including citrate 10,11 and recombinant tissue plasminogen activator (rt-PA). 12 Intradialytic locking with a thrombolytic agent has many appealing features.…”

mentioning

confidence: 99%

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Manns

Scott-Douglas²,

Ravani

et al. 2014

Journal of the American Society of Nephrology

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In a recent randomized trial, weekly recombinant tissue plasminogen activator (rt-PA), 1 mg per lumen, once per week, and twice-weekly heparin as a locking solution (rt-PA/heparin) resulted in lower risks of hemodialysis catheter malfunction and catheter-related bacteremia compared with thrice-weekly heparin (heparin alone). We collected detailed costs within this trial to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the 6-month trial. Nonparametric bootstrap estimates were used to derive 95% confidence intervals (CIs) and mean cost differences between the treatment groups. The cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. Overall, the difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was Can$323 (95% CI, 2$935 to $1581; P=0.62). When the costs were extrapolated over a 1-year time horizon using decision analysis, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. This finding was sensitive to plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term. In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin. Cost savings due to a lower risk of hospitalization for catheter-related bacteremia partially offset the increased cost of rt-PA.

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A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters†

Cited by 136 publications

References 16 publications

A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China

A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China

Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

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