Silastic cuffed catheters for hemodialysis vascular access: Thrombolytic and mechanical correction of malfunction

Catheter-Related Sheaths (CRS): Pathophysiology and Treatment Strategies

“…Subsequent retrospective studies have reported high technical success rates [56][57][58][59], but with less promising durable clinical results with 45% and 28% primary patency at 3 and 6 months respectively [58]. A study specifically evaluating HD catheter flow rates post stripping yielded more disappointing results: the average flow rate fell below host the institution's standard by the fifth hemodialysis session [56].…”

“…A study specifically evaluating HD catheter flow rates post stripping yielded more disappointing results: the average flow rate fell below host the institution's standard by the fifth hemodialysis session [56]. Suhocki found primary and secondary mean patency at 3 and 4.5 months respectively [59]. Johnstone found at 6 months primary and secondary patency rates of 40% and 60%, respectively [60].…”

Acute and Chronic Catheter in Hemodialysis

“…Fibrin sheaths account for 13-57% of catheter dysfunction (Suhocki et al 1996). The formation begins 24 hours after placement and it develops into a full-length sleeve after 5-7 days (Faintuch et al 2008).…”

“…A permcathogram done by injecting contrast through the catheter ports under fluoroscopic screening may show a persisting filling defect at the catheter tip or reflux of the contrast along the sheath in a retrograde direction (Figure 3). Fibrin sheaths may be treated by prolonged infusion of fibrinolytic agents (urokinase 30000 units/hour via each port x 4 hours or recombinant tissue plasminogen activator of 2.5 mg diluted in 50 ml normal saline at a rate of 17 ml/hour through each port x 3 hours), mechanical stripping using a snare inserted via the femoral vein by exchange of catheter over a guidewire (Suhocki et al 1996, Faintuch et al 2008, Goldberg et al 1985. Diverse degree of success in fibrin sheath stripping is reported from different centers.…”

Implantation of a New Access Device for Hemodialysis (Dialock): Initial Experience in 5 Patients

“…Ten to 20 % of hemodialysis patients are dependent on external catheters as a permanent access [1]. These include patients who have no other access sites available due to prior fistulas or poor vascular anatomy, and those awaiting the maturation of a newly created arteriovenous fistula or healing of a freshly implanted polytetrafluoroethylene graft.…”