Vascular Access in Patients Treated with Continuous Renal Replacement Therapy: A Report from a Single Center in China

Abstract

Our aim was to analyze the practice pattern of vascular access use and complication rates in patients receiving continuous renal replacement therapy from a large Chinese urban medical center. Patients who had received continuous renal replacement therapy (CRRT) from April to October 2014 in our center were included in this study. Demographic data, primary disease, department for hospitalization, blood pressure, heart rate, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, presence of mechanical ventilation, CRRT modalities, choice of functioning vascular access, site and duration of catheter insertion, presence of recatheterization, cumulative catheter indwelling time, catheter malfunction and catheter‐related infections, as well as laboratory test results, were collected. A total of 292 patients were enrolled in our study, including 175 males (59.9%) and 117 females (40.1%), aged 50.8 ± 18.6 years (range, 12 to 94 years). Acute kidney injury, multiple organ dysfunction syndrome, and systemic inflammatory response syndrome were the main indications for treatment with CRRT. Initial vascular access was non‐cuffed temporary catheters in 280 patients and was preferentially obtained in the right internal jugular vein (54.3%). There were 32 (11.4%) patients requiring re‐catheterization. Catheter malfunction occurred in 7.14% of all patients, and the median time of catheter malfunction was found at the 5th day. By multivariate analysis, it was found that the main risk factors of catheter malfunction were cumulative treatment time of CRRT and the level of hemoglobin. The average time of catheter‐related infections was 10.7 days after insertion and the catheter‐related infections occurred at a rate of 7.19 per 1000 catheter days. The main risk factors for catheter‐related infections were cumulative time of catheterization and the level of serum albumin. In this cohort of critically ill patients, the main risk factors for catheter malfunction were cumulative CRRT time and the level of hemoglobin. In addition, the main risk factors for catheter‐related infections were cumulative time of catheterization and the level of serum albumin.

Association of intermittent versus continuous hemodialysis modalities with mortality in the setting of acute stroke among patients with end-stage renal disease

“…Another consideration in terms of the use of CRRT versus IHD is the fact that patients with ESRD who have a graft or fistula, which equates to 19.4% of USRDS patients, require a new vascular access to be placed before CRRT can be initiated 13. This invasive procedure in an already critically ill patient comes with potential risks including but not limited to arterial puncture, hemothorax, pneumothorax, thrombus formation, and pericardial tamponade, along with the downstream complication of a catheter-related bloodstream infection following line placement 15-19. Given the low incidence of these complications, it is hard to determine the extent to which catheter placement deters CRRT use for clinicians and may be negligible.…”

“…13 This invasive procedure in an already critically ill patient comes with potential risks including but not limited to arterial puncture, hemothorax, pneumothorax, thrombus formation, and pericardial tamponade, along with the downstream complication of a catheter-related bloodstream infection following line placement. [15][16][17][18][19] Given the low incidence of these complications, it is hard to determine the extent to which catheter placement deters CRRT use for clinicians and may be negligible. Placing a catheter, however, does take time and has the potential to delay treatment of patients following their stroke which may lead to further complications.…”

Impact of Double-Machine Replacement Protocol at Start of Continuous Renal Replacement Therapy in Vasopressor-Dependent Patients: A Retrospective Cohort Study

“…Fluid overload was reported to be closely related to AKI occurrence, which was associated with the poorer clinical condition and increased risk of mortality in patients [17]. Besides, nurses' workload also increases as the conventional approach to CRRT circuit replacement requires returning the blood to the patient and sealing the vascular access with anticoagulation before a new CRRT circuit replacement starts to prevent catheter malfunction [18].…”