Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose

Abstract

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.

Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial

“…4 Continuous Renal Replacement Therapies (CRRT) relies on the maintenance of extracorporeal circuit (EC) patency for as long as possible, however premature circuit failure due to clotting may cause blood loss, reduced therapeutic efficacy and increased workload and treatment costs. [5][6][7][8] Clogging and clotting of the hemofilter membrane is the major mechanism of premature failure and circuit loss in CRRT. 9,10 It has been suggested that increasing blood flow rate (BFR) through the EC to speeds greater than 200 mL/min may reduce premature clotting.…”

Vascular Access Site for Renal Replacement Therapy in Acute Kidney Injury: A Post hoc Analysis of the ATN Study

“…The choice of dialysis catheter location will likely continue to depend on physician experience and patient characteristics, for example, patients with high BMI receiving internal jugular catheters. Femoral catheters often are, and likely will remain, the site of choice in the cases of emergencies (1, 16). …”

Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?

“…To the best of our knowledge, this study is the first to assess the risk of DC dysfunction when DCs are placed by GWE rather than by VPI in the ICU setting. Several characteristics may predispose to DC dysfunction such as catheter material [ 26 ], length [ 10 ], gauge [ 27 ], insertion site [ 10 ] and blood flow velocity through the DC [ 10 ]. In the ELVIS study the DC characteristics and causes of DC dysfunctions were not recorded, which restricted our ability to elaborate on the mechanisms involved.…”