Strategies to Reduce Hemodialysis Catheter-related Complications

The objective of the studies presented in this thesis was to reduce hemodialysis catheter-related complications by studying the influence of the following issues. In Chapter 3 we address the best cannulation site once the time period a hemodialysis catheter is needed has been estimated. We showed that untunneled femoral catheters should not be left in place for more than 5-7 days because of the high risk of infections. We also demonstrated that untunneled jugular catheters used for more than 3 weeks give high infection rates and the use of an untunneled jugular catheter should be preferred when a catheter is needed for the longer time periods. In Chapter 4 we describe that a novel design untunneled jugular catheter can reduce catheter-related complications and can be used safely for a time period of three months. In Chapter 5 we describe the construction and potential flaws in the manufacturing process from a fractured silicone hemodialysis catheter by performing an extensive scanning electron microscopy study and using energy-dispersive X-ray spectral analysis to determine the components of the catheter. The geometry, tip design of catheters and the application of side-holes have been determined mainly by methods of trial and error. In the second study presented in Chapter 5 we performed an in vitro study on the fluid dynamics of four different types of tunneled and untunneled catheters and demonstrated that side holes should not be used in catheters. Catheters have to be locked with a solution for the interdialytic period. It is well known that locking solutions leak out from the tip of the catheter, but the clinical implications of this feature are not clear. Traditionally, heparin is installed but there are no studies to support this practice. Local acting antimicrobial locking solutions could be an attractive alternative. Low and high concentrations of trisodium citrate (TSC) have been advocated. In Chapter 6 we describe the antimicrobial properties of 4 different concentrations of TSC in vitro, using two classical antimicrobial susceptibility tests and showed that 30% TSC is the optimal concentration for a catheter locking solution to be used in a multicenter double blind randomised controlled trial. The outcome of this trial is described in the second part of Chapter 6. In this study we compared heparin with TSC and showed an important reduction in infectious complications. We also demonstrated a reduction in bleeding complications in patients that had TSC installed in their catheter.Wee, P.M. ter [Promotor

Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study

Background: The main limitations of central venous catheters for haemodialysis access are infections and catheter malfunction. Our objective was to assess whether precurved non-tunnelled central venous catheters are comparable to tunnelled central venous catheters in terms of infection and catheter malfunction and to assess whether precurved non-tunnelled catheters are superior to straight catheters. Materials and methods: In this retrospective, observational cohort study, adult patients in whom a central venous catheter for haemodialysis was inserted between 2012 and 2016 were included. The primary endpoint was a combined endpoint consisting of the first occurrence of either an infection or catheter malfunction. The secondary endpoint was a combined endpoint of the removal of the central venous catheter due to either an infection or a catheter malfunction. Using multivariable analysis, cause-specific hazard ratios for endpoints were calculated for tunnelled catheter versus precurved non-tunnelled catheter, tunnelled catheter versus non-tunnelled catheter, and precurved versus straight nontunnelled catheter. Results: A total of 1603 patients were included. No difference in reaching the primary endpoint was seen between tunnelled catheters, compared to precurved non-tunnelled catheters (hazard ratio, 0.91; 95% confidence interval, 0.70– 1.19, p=0.48). Tunnelled catheters were removed less often, compared to precurved non-tunnelled catheters (hazard ratio, 0.65; 9

Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters:A retrospective cohort study

Clinical epidemiolog

A Randomized Trial of Liposomal Prednisolone (LIPMAT) to Enhance Radiocephalic Fistula Maturation: A Pilot Study

Vascular Surger

Acesso vascular para hemodiálise com cateter temporário de duplo lúmen em cães com insuficiência renal aguda Hemodialysis vascular access with temporary double-lumen catheter in dogs with acute renal failure

A hemodiálise é uma modalidade terapêutica que pode sustentar a vida do paciente com insuficiência renal aguda (IRA), enquanto este recupera a função renal. Para sua realização, é necessário estabelecer circulação extracorpórea, para que seja realizada a filtração do sangue, impondo a necessidade de um acesso vascular viável e eficiente. O objetivo deste estudo foi avaliar a eficiência e as complicações do acesso vascular para hemodiálise (HD), com cateter temporário de duplo lúmen inserido na veia jugular externa. Foram estudados 10 cães com IRA induzida por gentamicina, submetidos a sessões diárias de HD, com duração de uma hora, até a recuperação da função renal ou óbito. Foram realizadas 104 sessões de HD nos animais estudados, observando-se necessidade de troca do cateter em sete sessões (6,7%), devido à obstrução do lúmen do cateter em seis sessões (5,8%) ou por saída acidental do mesmo em uma sessão (1,0%). Não se observou migração do cateter, infecção, hemorragia ou hematoma no local de entrada do cateter na pele, obtendo-se fluxo sanguíneo patente em 90,4% das sessões. Concluiu-se que o acesso vascular na veia jugular externa com cateter temporário de duplo-lúmen mostrou-se viável, com ocorrência de poucas complicações, sendo, portanto, indicado como forma de acesso para a circulação extracorpórea para HD em cães com IRA.<br>Hemodialysis is a therapeutic procedure that can sustain the patient's life in acute renal failure (ARF), during the renal function recover. To perform hemodialysis (HD), an extracorporeal circulation is established to blood filtration, imposing the need of a viable and efficient vascular access. The aim of this study was to evaluate the effectiveness and complications of the HD vascular access with temporary double-lumen catheter inserted into the external jugular vein. Ten mongrel dogs with ARF, induced by gentamicin administration, were submitted to daily hemodialysis for one hour, until renal function recover or death. A total of 104 HD sessions were performed. Catheter replacement was accomplished in seven sessions (6.7%), due to catheter lumen mechanical obstruction in six sessions (5.8%) or accidental catheter output in one session (1.0%). No catheter migration, infection, bleeding or haematoma around the catheter insertion site was found. Effective blood flow rates were observed in 90.4% HD sessions. In conclusion, the vascular access in jugular external vein with temporary double-lumen catheter was valuable, with few complications, and should be indicated to vascular access in extracorporeal circulation to HD in ARF dogs