Percutaneous Blood Access for Hemodialysis

Twardowski, Zbylut J.

doi:10.1111/j.1525-139x.1995.tb00372.x

Cited by 27 publications

(4 citation statements)

References 89 publications

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“…However, infection-free survival was better in first catheters, suggesting a cumulative disadvantage with prolonged catheter use. The longer overall survival times for all catheters compared to infection-free survival suggests that, in the clinically stable patients with CRB, treatment of infection without removal of the catheters is a valid option [13,14,[27][28][29]. This could potentially avoid repeated manipulation of the access site and exposure to anesthesia, and preserve future access sites.…”

Section: Time (Days) Percent Survivalmentioning

confidence: 99%

Catheter survival and comparison of catheter exchange methods in children on hemodialysis

et al. 2007

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This retrospective study was done to compare the infection-free and overall survival of first and subsequent tunneled cuffed hemodialysis catheters in children. Subsequent catheters were exchanged by two different methods (a) removal and replacement (R&R), or (b) wire-guided exchange (WGE) using the same tunnel and vessel. The study involved 59 children (27 male, 32 female; mean age 13.9 +/- 4.6 years) undergoing maintenance hemodialysis in a pediatric unit over a period of 60 months. From a total of 175 catheters (57 first catheters, 81 WGE, 37 R&R) and 38,888 catheter days, 74/175 (42%) catheters were exchanged because of catheter-related bacteremia (CRB) and 43/175 (25%) for malfunction or cuff extrusion. One-year survival rates for first and consecutive catheters was 26% and 21%, respectively. The overall survival of first catheters, and those exchanged by WGE and R&R for both infectious and non-infectious reasons, was not statistically different. However, infection-free survival of first catheters was significantly prolonged in comparison with that of subsequent catheters (P < 0.001). The infection-free survival and the overall survival were not affected by etiology of primary disease, gender, serum albumin, or hemoglobin. Overall catheter survival increased with age >10 years. There was a significant association between gram-negative and polymicrobial CRB and requirement for R&R (P < 0.02). Our findings suggest that WGE is safe in a clinically stable child if the tunnel and the exit site are not infected and has the potential benefit of preserving the vascular access site. The shorter infection-free survival in subsequent catheters suggests a cumulative disadvantage with prolonged catheter use.

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Section: Time (Days) Percent Survivalmentioning

confidence: 99%

Catheter survival and comparison of catheter exchange methods in children on hemodialysis

et al. 2007

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“…30 The lower rate of accessrelated complications may result in longer dialysis sessions. 31 This again may lead to a higher dialysis dose, less frequent hospital admissions, and other untoward effects. 32 The fomentation was well tolerated and did not increase bleeding events during the study period.…”

Section: Discussionmentioning

confidence: 99%

Effect of Chinese Herbal Fomentation on Arteriovenous Fistula Maturation

Tong

Yuan

2011

The Journal of Alternative and Complementary Medicine

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“…Twardowsky suggested that “the lower the skill, the higher the rate of complications,” so the correct use of US for implantation will increase the operator’s skills. 45…”

Section: Discussionmentioning

confidence: 99%

Ultrasound in central venous access for hemodialysis

et al. 2021

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Central venous cannulation is a frequent need for urgent or scheduled hemodialysis. Many studies confirmed the pivotal role of ultrasound in this procedure. Vascular access guidelines strongly recommend ultrasound guidance. Its usefulness has been demonstrated not only in reducing complications of venipuncture but more recently for the evaluation of central venous catheter (CVC) placement and real-time check for possible complications. The use of ultrasound requires a precise technique for the correct handling of the probe and the needle movement. Different approaches as the out-of-plane, in-plane, and oblique methods are available, enabling the most appropriate for the individual case. Although the learning curve for CVC ultrasound placement is usually fast, formal training and certification for beginners are strongly recommended.

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Percutaneous Blood Access for Hemodialysis

Cited by 27 publications

References 89 publications

Catheter survival and comparison of catheter exchange methods in children on hemodialysis

Catheter survival and comparison of catheter exchange methods in children on hemodialysis

Effect of Chinese Herbal Fomentation on Arteriovenous Fistula Maturation

Ultrasound in central venous access for hemodialysis

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