REDUCING TUNNELED HEMODIALYSIS CATHETER MORBIDITY: Advances in Tunneled Central Venous Catheters for Dialysis: Design and Performance

Self-centering, split-tip catheter has better patency than symmetric-tip tunneled hemodialysis catheter: single-center retrospective analysis

The performance and safety of a new self-centering, split-tip hemodialysis tunneled catheter was compared with a symmetric-tip catheter. The new catheter has a greater separation between the arterial and venous tips, with dual apertures designed to permanently face the center of the blood vessel. The design is intended to improve dialysis efficiency by increasing flow rates while decreasing recirculation, fibrin sheath formation, thrombosis, and vessel wall occlusions. The study results indicated that the self-centering, split-tip catheter had statistically greater patency after 3 months with similar clearance, blood flow, and safety.

Hemodialysis catheter thrombi: visualization and quantification of microstructures and cellular composition

PURPOSE

Despite the increasing use of central venous catheters (CVC) for hemodialysis in clinical practice, the role of CVC in thrombus development is poorly understood. This work aims at defining new methods and protocols for assessing the micromorphology and composition of thrombi formed into tunneled and non-tunneled hemodialysis CVC removed from patients. 


METHODS

Twenty-nine CVCs were collected and the microscopic features of intra-luminal thrombi were quantified by scanning electron microscopy (SEM) and visualized by two photon laser scanning microscopy (TPLSM). 


RESULTS

SEM quantification showed that fibrin was the most abundant structure in CVC thrombi. Specifically, the median micromorphologic composition of the surface layer resulted in: 42.6% of fibrin plaque, 16.3% of fibrin network, 0.4% of fibrin fibers, 9.3% of platelets, 10.3% of erythrocytes and 1.7% of white blood cells. TPLSM showed that sub-surface layers were instead composed by smaller amounts of fibrin and platelets and higher amounts of blood cells.


CONCLUSIONS

Integration of SEM and TPLSM was found to be an excellent tool for characterizing thrombi in hemodialysis CVC removed from patients. Protocols and techniques presented here may be useful in the development and testing of new strategies for limiting thrombus formation on vascular access because of CVC.

[Tunneled hemodialysis catheters complications: a retrospective and monocentric comparative study of two devices]

PURPOSE

In a monocentric retrospective study, two tunneled hemodialysis catheters have been compared: a twin cylinder catheter (Dualcath) and a split tip catheter (Hemosplit).

PATIENTS AND METHODS

Patients who got catheters from January 1st 2007 to December 31st 2008 have been selected. Thrombotic events, as well as infectious events, were recorded in their dialysis file during this period of time.

MAIN RESULTS

The study was carried out on 50 patients. Thirty of them were given Dualcath, 23 were given Hemosplit, and three both of them. A Kaplan-Meier analysis has enabled to draw up the catheter survival curves, and the log-rank test enables to establish a survival of 93.1% at 20 months for Dualcath while 42.2% for Hemosplit. As far as the thrombotic complications with catheter incident are concerned, their incidence is 25.5 and 46.4 out of 1000 catheter-days (P<0,0001). The ones with catheter manipulation have incidences of 6.78 and 9.33 out of 1000 catheter-days, respectively for Dualcath and Hemosplit (NS). Dualcath presents catheter-related infections with a rate of 4.38 out of 1000-catheter days while 5.07 for Hemosplit (NS).

CONCLUSION

The Dualcath catheter presents a better survival than the Hemosplit catheter as well as weaker incident type thrombotic complications.

[Safety and quality in intensive care medicine]

The safety and quality care are two attributes of the health care that are closely intertwined. Quality is a feature of the system that delivers health care, thereby improving it, we need a proper reorganization teamwork. Measurements of quality are intended to assess whether the process of health care reaches the desired objectives, while avoiding the processes that predispose to harm the patient. The critically ill patients are vulnerable to medical errors, and may experience side effects preventable, often associated with: medications, mechanical ventilation, and intravascular devices. The evidence currently available suggest that the safety and quality of care can be improved. In this article presents some of the strategies and interventions developed to optimize the processes of care in critically ill patients, and improve the safety culture in the ICU.

Tunneled dialysis catheters: recent trends and future directions

Despite aggressive efforts to increase autogenous fistula prevalence primarily from recommendations by the NKF and the Fistula First National Vascular Access Improvement Initiative, catheters remain an essential access modality for a large percentage of the hemodialysis population. Tunneled dialysis catheters or chronic catheters are associated with a multitude of complications including infections, stenosis, thrombosis, and increased morbidity and mortality even after adjustment for potential confounding variables. Also, given the blood flow rates of catheters, dialysis adequacy is compromised as compared with arteriovenous fistulae and arteriovenous grafts. This review endeavors to provide an update on catheter outcomes in the Fistula First and Kidney Disease Outcomes Quality Initiative era in relation to the increasing fistula prevalence and decline in graft placements. The conflicting view of whether catheters are increasing concurrently with the increase in fistula prevalence is discussed. The management of tunneled dialysis catheter-related complications is considered with a review of the most recent data. Future research strategies and innovations in catheter design are also addressed. This review provides a comprehensive update of tunneled hemodialysis catheters, their necessity and pitfalls, and novel directions for future investigation.