Blood recirculation in malfunctioning catheters for haemodialysis

Crespo, Rodolfo; Rivero, Morales; Contreras, M.D.; Martínez, Ana Belén; Labrador, Ángel Matute; Jurado, María José; Casas, Raúl

doi:10.1111/j.1755-6686.1999.tb00012.x

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…The degree of REC found in the totality of the catheters in this study is similar to that published in other works (3)(4)(5)(6). When the closely linked variables were related, a strong correlation was found between the drop in pre-pump pressure in the arterial line and the drop in real blood flow (Figure 1), which is logical given that the deviation of real blood flow with regard to theoretical flow depends directly on the drop of pressure in the arterial line.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of blood recirculation in catheters for haemodialysis and its relation to blood circuit pressures

et al. 2002

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Summary The objectives of this study were to evaluate the degree of blood recirculation (REC) in venous catheters for dual lumen haemodialysis, and its relation to the drop in arterial line pressure and return venous pressure during haemodialysis. A total of 25 catheters were evaluated (15 temporary 15 cm catheters, and 10 permanent tunnelled 32 cm catheters). REC was calculated using a blood temperature monitor. With blood flow stabilised at 250 ml/min, the session was initiated and the following was determined: real blood flow, drop in arterial line pressure (pre‐pump pressure), positive pressure and blood recirculation. Mean blood recirculation in the total of catheters was 6.4 ± 3%, mean real blood flow was 230 ± 9 ml/min. Mean blood pressure was −146 ± 52 mmHG. Mean positive pressure was 127 ± 47 mmHG. A strong correlation was found between real flow and arterial pressure (r = 0.79, p < 0.01), and between arterial pressure and blood recirculation (r = −0.57, p < 0.01). Comparing the variables studied, a lower degree of REC (5.2±2 vs. 8.5±3, p < 0.01), a higher real blood flow (234 ± 7 vs. 223 ± 7, p < 0.01) and a lower drop in arterial pressure (–127 ± 49 vs. −180 ± 40, p < 0.05) were found in temporary catheters than in permanent catheters. No differences were observed in positive pressure. As a conclusion, these results suggest that blood recirculation is lower in temporary catheters than in permanent tunnelled catheters. This is related to a lower drop in pre‐pump blood pressure and a higher real blood flow. However, positive pressure does not seem to influence the degree of blood recirculation in venous dual lumen catheters for haemodialysis.

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Section: Discussionsupporting

confidence: 91%

Evaluation of blood recirculation in catheters for haemodialysis and its relation to blood circuit pressures

et al. 2002

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“…Previous small studies have reported that the prevalence of access recirculation (AR) ranges between 5% and 22% at conventionally prescribed blood flows, depending on catheter location and length and blood line position. [5][6][7][8][9][10][11][12][13][14][15] Although it is known that AR is more common in CVC than in arteriovenous accesses, the frequency of severe AR (Ͼ10%) is unknown, and the relation between AR, blood pump speeds (Q B ), and effective small solute clearance has not been previously described, to our knowledge.…”

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confidence: 99%

Optimizing Dialysis Delivery in Tunneled Dialysis Catheters

Pannu¹,

Jhangri²

2006

ASAIO Journal

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Long-term dialysis is often delivered through tunneled central venous catheters (CVC) despite their associated morbidity and mortality rates. Because poor solute clearance might contribute to this risk, we examined the relation between blood pump speed (QB), access recirculation (AR), and dialysis delivery in patients with CVC. We conducted a prospective study on 102 patients receiving long-term hemodialysis with CVC. QB was systematically varied, and AR was measured by saline dilution with the blood supply lines in both the straight and the reversed positions during each of two dialysis sessions. During a third session, we measured ionic dialysance (EID) in patients with AR>0% and those in whom dialysis was usually delivered with catheters in the reversed position.Approximately one third (34.3%) of patients were usually run in the reversed position. Clinically significant AR (>10%) was infrequent (3%) in the straight position but common in the reversed position (86%). QB and EID were linearly correlated for both the straight and reversed positions. Approximately half (48.6%) of patients who were generally treated with their lines reversed were able to receive dialysis with the lines in the straight position within acceptable pressure limits when blood lines were switched part way through the run. In these patients, solute clearance was equivalent (EID straight 204 ml/min vs. reversed 196 ml/min, p=0.58) with lines in the straight configuration despite lower achieved QB (straight 354 ml/min vs. reversed 404 ml/min, p=0.04). Maximization of prescribed QB in CVC increased AR when blood line position was reversed but improved small solute clearance regardless of line position. This suggests that QB in CVC should be set as high as circuit pressure limits will allow, regardless of the potential for AR, and that reversal of line position confers no benefit with respect to solute clearance.

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“…In well‐functioning catheters recirculation is typically negligible. When lumens are reversed, however, recirculation may be as high as 15% (14–16). Based on recommended guidelines, if recirculation exceeds 10% using the urea‐based method, investigation into the etiology should ensue (2).…”

Section: Definitionsmentioning

confidence: 99%

Hemodialysis Central Venous Catheter Dysfunction

Chan

2008

Seminars in Dialysis

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Despite aggressive efforts to increase autogenous fistula prevalence, catheters remain an essential access modality to a large percentage of the hemodialysis population. Central venous catheter dysfunction, which includes catheterrelated bacteremia and thrombotic occlusion, comprises the majority of complications which affect dialysis adequacy, patient quality of life, patient survival, and the economics of health care. This review provides a comprehensive overview of hemodialysis central venous catheter dysfunction, its epidemiology and risk factors, and avenues of prevention and treatment. Novel directions for future investigation are also addressed.

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Blood recirculation in malfunctioning catheters for haemodialysis

Cited by 8 publications

References 3 publications

Evaluation of blood recirculation in catheters for haemodialysis and its relation to blood circuit pressures

Evaluation of blood recirculation in catheters for haemodialysis and its relation to blood circuit pressures

Optimizing Dialysis Delivery in Tunneled Dialysis Catheters

Hemodialysis Central Venous Catheter Dysfunction

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