Catheter Management in Hemodialysis Patients

Abstract

SummaryOver 330,000 individuals in the United States depend on hemodialysis (HD), the majority as a result of endstage renal disease. Sustainable vascular access can be achieved through arteriovenous fistulas, arteriovenous grafts, or tunneled catheters. Tunneled dialysis catheters (TDCs) often remain in use for months or even years, long beyond their initial intended use as a bridging device. Research efforts are focused on identifying strategies to prevent/minimize the risk of the most common catheter-related complications: thrombotic occlusion and infection. Thrombotic occlusion of TDCs prevents adequate dialysis but can be managed successfully through thrombolytic agents to restore/improve blood flow in the majority of patients, allowing immediate HD delivery and prolonging usability of the TDC. Occasionally, catheter exchange with fibrin sheath disruption is needed to preserve the site. Surface-treated catheters could improve the morbidity and mortality associated with HD delivery via an indwelling catheter, but results from studies have been disappointing to date. We review the etiology of catheter-based access failure and the monitoring and interventional steps that should be taken to maintain the patency and safety of catheters for HD. Wherever possible we note the areas in which there is scant data where further randomized clinical trials are needed.

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

“…This suggests that catheter dysfunction may have been due to extra-luminal formation of fibrin sheaths or non-occlusive clots, rather than luminal problems. Due to a significant leakage of the instilled lock solution over time, as evident from experimental work and the well documented systemic anticoagulation effect of heparin locks 27,[56][57][58] , it is possible that catheters locked with heparin are less likely to develop extra-luminal occlusion. This might explain the differences seen between catheters locked with Cathasept and heparin in this study, but confirmatory work would be required.…”

Peritoneal Dialysis Catheter Malfunction Because of Encasement by an Extraluminal Fibrin Sheath

“…Strategies to reduce fibrin sheath formation and to improve HD catheter function have been explored. The use of heparin locking solutions and thrombolytic therapies have been shown to improve HD catheter function (8). No clinical data have yet shown any benefit of antithrombotic coated HD catheters (9).…”

“…The syndrome has also been reported in individuals with normal renal function and in non-dialysis chronic kidney disease patients (3)(4)(5)(6). Despite a multidisciplinary approach, management of CUA is challenging because of a very high mortality-in the range 45% -80% (7)(8)(9)(10)(11). Since the year 2000, several reports have been published of a significant role for intravenous sodium thiosulfate (STS) in treating CUA (8,11).…”

Ambulating With Pulmonary Artery or Femoral Catheters in Place

“…Most cases of fibrin dislodgment occur during removal of venous catheters. 19 A fibrin sheath does not commonly contribute to thrombus formation. 19 An older study 20 indicated that as many as 8.5% of critically ill adults experienced femoral vein thrombosis when the catheter had been in place 8 days or longer.…”

“…19 A fibrin sheath does not commonly contribute to thrombus formation. 19 An older study 20 indicated that as many as 8.5% of critically ill adults experienced femoral vein thrombosis when the catheter had been in place 8 days or longer. However, these findings may not apply to patients receiving venothromboembolism prophylaxis or patients with newer silicon catheters.…”