Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Abstract

SummaryBackground and objectives Several temporary venous catheterizations are sometimes required for acute renal replacement therapy (RRT) in the intensive care unit (ICU). This study compares first and second catheterizations in the femoral and jugular veins in terms of patient safety.Design, setting, participants, & measurements A crossover study from the catheter-dialysis randomized study (Cathedia), which was conducted among 736 critically ill adults requiring RRT, was performed. Catheter insertion complications, catheter-tip colonization, catheter dysfunction and urea reduction ratio (URR) were analyzed considering the crossover and longitudinal designs.Results This study analyzed 134 patients who underwent two different sites of catheterization, 57 and 77 of whom were initially randomized in the femoral and jugular site, respectively. Using anatomic landmarks, time to insert a femoral catheter was shorter (P=0.01) and more successful (P=0.003) compared with catheterization in the jugular site. Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion (median, 14 days in both groups; hazard ratio, 0.99; 95% confidence interval, 0.61-1.59; P=0.96), as well as time to dysfunction. URRs were analyzed from 395 dialysis sessions (n=48 patients). No significant difference (P=0.49) in mean URR was detected between sessions performed through femoral (n=213; 50.9%) and jugular (n=182; 49.5%) dialysis catheters.Conclusions These results validate prior results of this study group and extend external validity to the second catheter used for RRT in the ICU. Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU.

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

“…Details of the dialysis catheters used in the Cathedia study were described elsewhere (7) and were consistent with those used in the CLock study. For the present analysis, we excluded patients who exclusively received continuous RRT and catheters that were not inserted first in the ICU (10).…”

Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose

“…Our study suggest that clinicians perceive the femoral vein to be a useful potential first choice when rapid and safe access is needed and in patients with a multilumen central venous catheter in the right jugular vein [6] . Our results reflect this preference with sicker patients (more severe acidemia, higher APACHE III and cardiovascular Sequential Organ Failure Assessment score and faster initiation of CRRT after ICU admission) being more likely to have their first CRRT catheter inserted in the femoral vein.…”

“…Femoral vein catheterization may be faster and easier than jugular vein catheterization [6] but may impede mobilization [7] . Thus, recent guidelines favor the right jugular vein in preference to femoral veins [8] .…”

Épuration extrarénale en réanimation adulte et pédiatrique. Recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF), avec la participation de la Société française d’anesthésie-réanimation (Sfar), du Groupe francophone de réanimation et urgences pédiatriques (GFRUP) et de la Société francophone de dialyse (SFD)

“…Seul le sous-groupe des patients ayant un index de masse corporelle supérieur à 28 kg/m 2 présente une augmentation du risque infectieux en fémoral. Dans la même étude prospective randomisée, l'absence de différence de colonisation entre voies jugulaire et fémorale a été confirmée par une analyse en cross-over du deuxième cathéter d'EER [42].…”