Right intra‐atrial catheter placement for hemodialysis in patients with multiple venous failure

Abstract

The purpose of this study is to evaluate the efficacy and safety of direct right atrial catheter insertion for hemodialysis in patients with multiple venous access failure. We retrospectively evaluated the charts of 27 patients with multiple venous access failure who had intra-atrial dialysis catheter placement between October 2005 and October 2010 in our clinic. Permanent right atrial dialysis catheters were placed through a right anterior mini-thoracotomy under intratracheal general anesthesia in all patients. Demographics of the cases, the patency rates of hemodialysis via atrial catheterization, existence of any catheter thrombosis, and catheter-related infections were documented and used in statistical analysis. Seventeen women (63%) and 10 men (37%) with the mean age of 59.0 ± 7.1 years (47-71) were enrolled in this study. Chronic renal failure was diagnosed for the mean of 78.9 ± 24.3 months (33-130). Five patients (18.5%) died. Ventricular fibrillation and myocardial infarction were the causes of death in the early postoperative period in two patients. Two of the remaining three patients died because of cerebrovascular events, and one patient died because of an unknown cause. Ten patients (37%) had been using anticoagulate agents (warfarin) because of concomitant disorders such as deep vein thrombosis, operated valve disease, and arrhythmias. Catheter thrombosis and malfunction was determined in three cases (11.1%). Intra-atrial hemodialysis catheterization is a safe and effective life-saving measure for the patients with multiple venous failure and without any possibility of peritoneal dialysis or renal transplantation.

Life-saving vascular access in vascular capital exhaustion: single center experience in intra-atrial catheters for hemodialysis

“…10,12 The causes of death were also different from those previously reported -cardiovascular (acute myocardial infarction and ventricular fibrillation 12 and metabolic. 10 The mean age of this population, well above of previously published series (66 years versus 49, 54 and 59 years), [10][11][12] may justify these poorer results. Patients who died in the early postoperative period were 76 and 69 years old, respectively, and had several comorbidities, reflected by their high Charlson comorbidity index, 6 and 7, respectively.…”

“…In the largest series described, most patients were also female (17/27; 63%). 12 This gender preponderance is probably related to the lower vascular access survival reported for women. 14 Bleeding and infectious situations were the main complications identified in the early postoperative period, which culminated in the death of two patients.…”

“…In the presented series, two episodes of IACrelated infection have been reported, only one of them with systemic repercussion. As suggested by other authors, 12 the reduced bacteremia may be associated with limited follow-up, careful surgical techniques and aseptic care in the manipulation of IAC for HD.…”

“…In their series of 27 patients, Oguz et al 12 did not report any bacteremia situation related to vascular access. In the presented series, two episodes of IACrelated infection have been reported, only one of them with systemic repercussion.…”

“…Since then, there have been several case reports, [7][8][9] and three small series were published. [10][11][12] The experience with these catheters in HD is limited and, although their use remains restricted to life-saving situations of multiple venous access failure, with no other possibility of alternative RRT, an analysis of survival on HD with IAC and associated complications is essential to consider the best therapeutic options.…”