III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: Update 2000

doi:10.1016/s0272-6386(01)70007-8

Cited by 778 publications

(51 citation statements)

References 160 publications

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“…The observed much higher rate of catheter malfunction placed in femoral vein corroborates the need to choose this location as a second choice and only for a few days [1, 6]. This is in agreement with previously published data [16].…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, there is no general evidence and agreement regarding the concentration of heparin used for catheter lock to prevent its thrombosis/malfunction. As found in the literature it varies between different centers, and even guidelines published by the National Kidney Foundation Dialysis Outcomes Quality Initiative do not give clear recommendations concerning this issue [6]. …”

Section: Discussionmentioning

confidence: 99%

“…For internal jugular and femoral veins, catheters of 18 and 20 cm in length were chosen, respectively. Femoral catheters were 20 cm long to avoid higher recirculation of blood during the dialysis session [6]. An ultrasound monitor was used for a precise localization of internal jugular veins.…”

Section: Methodsmentioning

confidence: 99%

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Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

et al. 2007

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Background/Aim: Non-tunneled, temporal hemodialysis (HD) catheters are commonly used as short-term vascular access for the HD procedure. One of their late complications is thrombotic occlusion of the catheter ensuing in their malfunction. A heparin lock is conventionally used for maintaining the patency of the catheter. The aim of the study was to evaluate the influence of heparin concentration used for locking the catheter canals (5,000 vs. 2,500 IU/ml) and some other clinical and laboratory variables at the time of temporal HD catheter functioning. Methods: Catheter malfunction was defined as the inability to attain and maintain a blood flow of at least 150 ml/min. 174 consecutive HD catheters inserted into jugular or femoral veins (114 patients) were followed up and remained in use for a total of 3,284 days. Results: Catheter thrombosis occurred in 53 cases (30.5%) during the study period, giving an overall rate of 16 episodes per 1,000 catheter-days at risk. In univariate Cox proportional hazard analysis, predictors of catheter dysfunction were: femoral localization (HR 4.92, 95% CI 4.30–5.50), acute renal failure (HR 1.75, 95% CI 1.18–2.32), higher mean ultrafiltration (UF) (HR 1.31, 95% CI 0.99–1.63) and higher concentration of hemoglobin (HR 1.15, 95% CI 0.99–1.33). The concentration of heparin used for canal locking did not influence the time of catheter functioning (HR 1.1, p = 0.7). In multivariate Cox proportional hazard analysis (χ² = 38.5, d.f. = 4, p < 0.0001) the remaining statistically independent predictors of catheter malfunction were: femoral localization (HR 5.94, 95% CI 5.27–6.61, p < 0.0001) and higher UF (HR 1.60, 95% CI 1.24–1.94, p < 0.01). Conclusions: A lower concentration of heparin (2,500 IU/ml) prevents catheter thrombosis as effectively as a standard one (5,000 IU/ml). Femoral localization of HD catheters and higher UF during the HD procedure are the factors predisposing for catheter malfunction.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

et al. 2007

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“…This position has been the subject of intense debate within recent years with the 2001 Kidney Disease Outcomes Quality Initiative (K/ DOQI) Clinical Practice Guidelines suggesting the tip be located in the SVC/right atrial junction for tunneled (cuffed) catheters and SVC/atrial junction or the SVC for non-tunneled catheters [28]. At our institution, we attempt to place the tip of the catheter in the proximal right atrium.…”

Section: Discussionmentioning

confidence: 99%

Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

Burton

O'Brien²,

Rajan³

2012

OJRad

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Purpose: To determine whether radiographic heart morphology and echocardiography findings were associated with early central venous catheter (CVC) failure in hemodialysis patients. Materials & Methods: All hemodialysis catheter insertions between 1996-2007 were captured in a combined nephrology radiology database. Factors were identified that may be associated with early catheter failure. Factors examined included: echocardiography findings, radiographic evidence of flattened heart border, boot-shaped heart and left ventricular hypertrophy as well as patient comorbidities and peri-procedural characteristics. Results: Of the 132 CVC failures in 132 patients, 67 (50.8%) occurred within 30 days of insertion. Early CVC failure was more likely to occur in patients who had insertions from the left side (

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“…Data analyzed was obtained during 2003, several years after the introduction of the National Kidney Foundation – Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) clinical practice guidelines (introduced in 1997) [12,13,14,15]. In this study, we compared the clinical outcome measures of anemia control measured by hemoglobin (Hb) concentrations and human recombinant erythropoietin (EPO) doses; albumin concentrations to assess nutrition/inflammation; and URR and Kt/V to assess adequacy; among prevalent hemodialysis patients by access types.…”

Section: Introductionmentioning

confidence: 99%

Influence of Vascular Access Type on Outcome Measures in Patients on Maintenance Hemodialysis

et al. 2008

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Background: Previous studies postulate that end-stage renal disease (ESRD) patients dialyzed with central venous catheters (CVC) have poorer outcomes compared to patients using arteriovenous fistulae (AVF) or arteriovenous grafts (AVG). Clinical practice guidelines should obviate these differences if access was not important. This study compared clinical measures of adequacy, anemia, and nutrition/inflammation in prevalent hemodialysis patients in 2003 by access type. Methods: Data from The Renal Network Data System were analyzed by univariate analysis of variance to compare Kt/V, URR, albumin, hemoglobin (Hb) and recombinant human erythropoietin (EPO) dose by access type, while adjusting for pertinent factors. Results: 12,501 patients were included. The access type distribution was AVF 36%, AVG 41%, and CVC 23%. CVC patients had lower mean URR, Kt/V, albumin concentration (p < 0.001) than other accesses. Serum Hbs were similar (p = 0.416), however EPO dose (U/kg/week) was higher in those dialyzed with CVC compared to AVF/AVG (p < 0.001). Conclusions: Despite practice guidelines, patients dialyzed via CVC have poorer outcome measures compared to other accesses. This suggests that AVF should be used and/or appropriate adjustments need to be made for those dialyzed with CVC to achieve equal outcomes. Further studies defining barriers need to be conducted.

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III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: Update 2000

Cited by 778 publications

References 160 publications

Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

Influence of Vascular Access Type on Outcome Measures in Patients on Maintenance Hemodialysis

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