A Randomized Trial of Catheters of Different Lengths to Achieve Right Atrium Versus Superior Vena Cava Placement for Continuous Renal Replacement Therapy

Background/Aims: The aim of this study was to examine the impact of different catheter tip positions on the life of the catheter, dysfunction, infection, and quality of hemodialysis and possible differences between the access site laterality in jugular-tunneled hemodialysis catheters. Methods: Catheters were evaluated for the following parameters: place of insertion, time of insertion, duration of use, and reason for removal. In all patients, the catheter tip position was checked using an X-ray. Results: The mean duration of implanted catheters with the tip placed in the cavo-atrial junction and right atrium was significantly longer. There were no differences in catheter functionality at follow-up or complications based on catheter laterality for each catheter tip position. Conclusion: According to our results, the localization of the catheter tip in superior vena cava still remains the least preferable method. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth to which the catheter tip is inserted into the body.

Section: Discussioncontrasting

confidence: 96%

The Different Impacts on the Long-Term Survival of Tunneled Internal Jugular Hemodialysis Catheters Based on Tip Position and Laterality

Premužić

Perkov²,

Smiljanić³

et al. 2017

“…stenosis, thrombophlebitis) and repeated catheter placements are often needed [52], the femoral approach is commonly preferred. Of note, recent data regarding filter life span suggest the superiority of the right internal jugular vein access (with the soft tip inside the right atrium) [53,54]. …”

Section: Adverse Events Related To Rrtmentioning

confidence: 99%

Handling Continuous Renal Replacement Therapy-Related Adverse Effects in Intensive Care Unit Patients: The Dialytrauma Concept

Moliner¹,

Honoré²,

Riera³

et al. 2012

Continuous renal replacement therapy (CRRT) is increasingly used for the management of critically ill patients. As a consequence, the incidence of complications that accompany CRRT is also rising. However, a standardized approach for preventing or minimizing these adverse events is lacking. Dialytrauma is a newly proposed concept that encompasses all harmful adverse events related to CRRT while providing a framework for prevention or, at the least, early recognition of these events in order to attenuate the consequences. A mainstay of this approach is the utilization of a dedicated checklist for improving CRRT quality and patient safety. In this context, we discuss the most important adverse effects of CRRT and review current strategies to minimize them.

“…Of note, however, the femoral catheters used in this study were short, measuring only 16.5 or 19.5 cm. To optimize blood flow and CRRT dose and to avoid recirculation, it is important that the catheter tip is placed in a large vein (external iliac and close of inferior vena cava) or in the right atrium [5,14,15] . Therefore, it is recommended that 24-cm catheters be used in the femoral position, and that 15-20 cm catheters be used for right jugular cannulations [16] .…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

“…Such circuit failures induce interruptions in treatment, which decrease the delivered CRRT dose and uremic control [4] . Moreover, they significantly increase nursing workload and treatment costs [5] . Thus, both choice of optimal insertion site and catheter characteristics are important to delivering optimal therapy.…”

Section: Introductionmentioning

confidence: 99%

Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose

Bellomo

Mårtensson

et al. 2015

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.