Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly

Haddad, Nabil J.

doi:10.2174/1874303x01205010012

Cited by 12 publications

(12 citation statements)

References 31 publications

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“…For a given magnetic field strength, the deflection angle φ decreases as a function of misalignment θ which can be used to ensure that the magnet is oriented properly during actuation (n = 3). Theoretical line calculated for sample with v m = 0.003 mm 3 , L = 405 μm, t = 12 μm and w = 47.5 μm Optical images of catheter pore before and after blood clot obstruction removal: (a) before blood clot occlusion, (b) occluded catheter pore, (c) during actuation, and (d) after the blood clot removal. (scale bar = 1 mm) (e) Corresponding frequency responses before and after blood clot obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Indwelling catheters are one of the most widely used medical devices for the treatment and the management of various chronic cardiovascular, intravascular, neurological, and urological disorders [1]- [3]. Specialized catheters such as central venous access device and insulin infusion sets are also used often to continuously deliver various life-saving drugs for cancer and diabetes patients [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Piezoresistor-Embedded Multifunctional Magnetic Microactuators for Implantable Self-Clearing Catheter

et al. 2019

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Indwelling catheters are used widely in medicine to treat various chronic medical conditions. However, chronic implantation of catheters often leads to a premature failure due to biofilm accumulation. Previously we reported on the development of a self-clearing catheter by integrating polymer-based microscale magnetic actuators. The microactuator provides an active antibiofouling mechanism to disrupt and remove adsorbed biofilm on demand using an externally applied stimulus. During an in vivo evaluation of self-clearing catheter, we realized that it is important to periodically monitor the performance of implanted microactuators. Here we integrate gold-based piezoresistive strain-gauge on our magnetic microactuators to directly monitor the device deflection with good sensitivity (0.035%/Deg) and linear range (±30°). With the integrated strain-gauge, we demonstrate the multi-functional capabilities of our magnetic microactuators that enable device alignment, flow-rate measurement, and obstruction detection and removal towards the development of chronically implantable self-clearing smart catheter.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Piezoresistor-Embedded Multifunctional Magnetic Microactuators for Implantable Self-Clearing Catheter

et al. 2019

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“… 5 Long-term complications include catheter thrombosis, central vein stenosis, fibrin sheath formation, and catheter-related infections with their sequelae. 28 Therefore, clinical scenarios where tunneled cuffed hemodialysis catheter use may be appropriately considered include the following:…”

Section: Indications For Tunneled Catheter Usementioning

confidence: 99%

“…Ideally, the catheter should be inserted on the opposite side of a maturing or planned arteriovenous access. 12 , 28 , 32 , 33 , 39 …”

Section: Tunneled Cuffed Catheter Insertionmentioning

confidence: 99%

Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters

Clark

Kappel

MacRae

et al. 2016

Can J Kidney Health Dis

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Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance.

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“…The central venous catheter (CVC) is only recommended for short-term use due to high rates of infection, and is used as a transitional access for patients who have received AVF creation or AVG implantation surgery but need dialysis before the AV conduits become ready. The tunneled CVC has a subcutaneous cuff that could potentially render it suitable for long-term use (months to years), but this is not a standard practice due to the many complications associated with CVCs [16]. All three types of vascular access produce aberrant flow conditions that could lead to neointimal hyperplasia, thrombosis, stenosis and eventual occlusion.…”

Section: Major Clinical Problems For Chronic Hemodialysis Vascular Acmentioning

confidence: 99%

Hemodynamic Shear Stress and Endothelial Dysfunction in Hemodialysis Access

Fitts¹,

Pike²,

Anderson³

et al. 2014

TOUNJ

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Surgically-created blood conduits used for chronic hemodialysis, including native arteriovenous fistulas (AVFs) and synthetic AV grafts (AVGs), are the lifeline for kidney failure patients. Unfortunately, each has its own limitations: AVFs often fail to mature to become useful for dialysis and AVGs often fail due to stenosis as a result of neointimal hyperplasia, which preferentially forms at the graft-venous anastomosis. No clinical therapies are currently available to significantly promote AVF maturation or prevent neointimal hyperplasia in AVGs. Central to devising strategies to solve these problems is a complete mechanistic understanding of the pathophysiological processes. The pathology of arteriovenous access problems is likely multi-factorial. This review focuses on the roles of fluid-wall shear stress (WSS) and endothelial cells (ECs). In arteriovenous access, shunting of arterial blood flow directly into the vein drastically alters the hemodynamics in the vein. These hemodynamic changes are likely major contributors to non-maturation of an AVF vein and/or formation of neointimal hyperplasia at the venous anastomosis of an AVG. ECs separate blood from other vascular wall cells and also influence the phenotype of these other cells. In arteriovenous access, the responses of ECs to aberrant WSS may subsequently lead to AVF non-maturation and/or AVG stenosis. This review provides an overview of the methods for characterizing blood flow and calculating WSS in arteriovenous access and discusses EC responses to arteriovenous hemodynamics. This review also discusses the role of WSS in the pathology of arteriovenous access, as well as confounding factors that modulate the impact of WSS.

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Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly

Cited by 12 publications

References 31 publications

Piezoresistor-Embedded Multifunctional Magnetic Microactuators for Implantable Self-Clearing Catheter

Piezoresistor-Embedded Multifunctional Magnetic Microactuators for Implantable Self-Clearing Catheter

Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters

Hemodynamic Shear Stress and Endothelial Dysfunction in Hemodialysis Access

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