Reducing central venous catheter use in haemodialysis

Allon, Michael

doi:10.1038/nrneph.2015.56

Cited by 2 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Odds of all cause, cardiovascular, and infectious mortality are 3.7, 2.8, and 6.6, respectively, in patients who use tunneled catheters as compared to those who use AVFs . Even in the elderly, catheter use is associated with infection, hospitalization, and high mortality rates . Catheter use has declined to 19% among prevalent dialysis patients, likely because of educational efforts by dialysis facilities in response to reimbursement metrics set by CMS, but at the time of dialysis initiation up to 80% of patients are still using a tunneled catheter…”

Section: Current Gaps In Care Around Clinical and Psychosocial Risk Fmentioning

confidence: 99%

“…2,65 Even in the elderly, catheter use is associated with infection, hospitalization, and high mortality rates. [66][67][68] Catheter use has declined to 19% among prevalent dialysis patients, likely because of educational efforts by dialysis facilities in response to reimbursement metrics set by CMS, but at the time of dialysis initiation up to 80% of patients are still using a tunneled catheter. 7,11,16,65 Another risk factor for infectious complications in patients on hemodialysis relates to their nutritional resilience.…”

Section: Infectionsmentioning

confidence: 99%

See 1 more Smart Citation

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Golestaneh

2018

Seminars in Dialysis

View full text Add to dashboard Cite

Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categories include: (1) fluid (interdialytic weight gain (IDWG) and chronic volume status), (2) infection (vascular access and malnutrition/inflammation resilience), and c) psychosocial (poor social support, poor self-efficacy, and mood disorders) risks. Barriers to improving hospitalization outcomes, especially as they relate to above risk categories, exist at multiple stakeholder levels and include: (1) dialysis facilities (strict shift changes, personnel challenges), (2) nephrologists (static dialysis prescriptions and protocols based on dialysis facility metrics), and (3) patients (lack of engagement and self-efficacy). System-level elements, such as payment models, help to propagate these barriers. In this article, we seek to shift the care paradigm discussion to patient trajectories and long-term outcomes, and to active engagement of patients as self-managers, through which we hope to impact on high inpatient resource utilization. We will also focus attention on the complex interplay of practices that have become acceptable care structures, but that may be deleterious to outcomes. Only after thorough consideration of these topics can we hope to impact on this important problem.

show abstract

Section: Current Gaps In Care Around Clinical and Psychosocial Risk Fmentioning

confidence: 99%

Section: Infectionsmentioning

confidence: 99%

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Golestaneh

2018

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…Arteriovenous fistula (AVF) is widely recognized as preferred access for most hemodialysis patients because it provides the best outcomes compared with an arteriovenous graft (AVG) or tunneled cuffed dialysis catheter (TDC)[ 2 ]. Catheter access has been used in 10% hemodialysis patients in China[ 3 , 4 ] and in 15% hemodialysis patients in the US according to the recent Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor (DPM) data, despite a great effort to reduce its use.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein

Wang

Qiao

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

BackgroundRight internal jugular vein (IJV) is a preferred access route for tunneled (cuffed) dialysis catheters (TDCs), and both right external jugular vein (EJV) and left IJV are alternative routes for patients in case the right IJV isn’t available for TDC placement. This retrospective study aimed to determine if a disparity exists between the two alternative routes in hemodialysis patients in terms of outcomes of TDCs.Methods49 hemodialysis patients who required TDCs through right EJV (n = 21) or left IJV (n = 28) as long-term vascular access were included in this study. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections (CRBSI).ResultsA total of 20,870 catheter-days were evaluated and the median was 384 (interquartile range, 262–605) catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group (P = 0.007). Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group (P = 0.031). There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212 (95% CI, 1.363–3.588; p = 0.001).ConclusionsRight EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.

show abstract

Reducing central venous catheter use in haemodialysis

Abstract: Refers to Malas, M. B. et al. Trends in incident hemodialysis access and mortality. JAMA Surg. http://dx.

Cited by 2 publications

References 9 publications

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein

Contact Info

Product

Resources

About