Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients

Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study

OBJECTIVES

To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities.

DESIGN

A propensity-score matched cohort study.

SETTING

A 980-bed tertiary referral hospital in South West Sydney, Australia.

PARTICIPANTS

In-patients referred to the hospital central venous access service for the insertion of a central venous access device.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT).

RESULTS

The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00).

CONCLUSION

There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.

Transhepatic double lumen hemodialysis catheter in exhausted vascular access: Feasibility, functionality, and outcome among hemodialysis patients

INTRODUCTION

Permanent arteriovenous fistula and graft are considered the best options for hemodialysis in end-stage renal disease patients. Temporary access using the internal jugular or femoral veins is the feasible option in acute cases of dialysis and if permanent access is unavailable. Occasionally, however, these access sites are unusable after consecutive blockage of the upper and lower extremities veins. A transhepatic or translumbar approach might be the only unconventional way to ensure a sufficient blood flow for adequate dialysis.

METHOD

Retrospective data on all transhepatic catheters (THCs) in patients at the King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia were collected. The catheters were inserted over a 10-year period (2009-2019). A minimum of 1 year of follow-up from the last catheter insertion was considered for analysis.

RESULTS

A total of 12 patients had THCs with a mean age of 42.5 ± 12.2 and pre-insertion mean dialysis duration of 130.0 ± 72.9 months. All catheters were functional from the start with no immediate complications. A total of 35 catheter replacements over guidewires were made with a median of 2.0 catheters (range of 0-10). The mean blood flow was 300 ± 30 ml/minute with a mean Kt/v of 1.4 ± 0.4. The median initial (primary) device service interval was 68 (range 6-1531 days) and the median total access site service interval was 392 (range 76-2698 days). Catheter complications included catheter migration, thrombosis, and bloodstream infection occurring at a rate of 0.12, 0.18, and 0.046 per 100 catheter days respectively.

CONCLUSIONS

Transhepatic catheters provide safe, feasible access in patients with exhausted vascular access. Patients who undergo THC insertion should be worked up for innovative permanent vascular access or urgent transplantation utilizing unconventional vascular techniques to avoid death due to lack of access.

Tunneled femoral dialysis catheter: Practical pointers

One of the most challenging aspects of providing end-stage kidney disease care is to achieve adequate long-term access to the bloodstream to support hemodialysis (HD) therapy. Although upper extremity arteriovenous fistula remains the vascular access of choice for patients on HD, complications such as central venous stenosis, access thrombosis, or exhaustion of suitable access sites in the upper extremity, ultimately result in pursuing vascular access creation in the lower extremity. The current review focuses on the indications, contraindications, and clinically relevant practical procedural tips to successfully place a tunneled femoral dialysis catheter. The review highlights some of the prevailing misconceptions regarding femoral catheter placement practices.

ACR Appropriateness Criteria® Central Venous Access Device and Site Selection

The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge. Central venous access devices may be nontunneled, tunneled, or implantable. They may be centrally or peripherally inserted by way of veins in the neck, extremities, or elsewhere. Each device and access site presents specific risks that should be considered in each clinical scenario to minimize the risk of harm. The risk of infection and mechanical injury should be minimized in all patients. In hemodialysis patients, preservation of future access is an additional important consideration. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Tunneled Hemodialysis Catheter Insertion: Technical and Clinical Considerations

Tunneled hemodialysis catheter insertion is a common and important procedure. Clinicians involved in the placement or maintenance of tunneled catheters require an appreciation of their best clinical application. Although comprehensive guidelines are available, many aspects of the published literature on this subject remain uncertain. This primer offers a concise, evidence-based discussion of 10 fundamental, everyday questions with respect to tunneled hemodialysis catheter insertion.

The Patency Rate of the Primary and Exchanged Femoral Haemodialysis Catheters

Background

This prospective cohort study aims to evaluate the primary and exchanged femoral catheter patency rates, as well as mortality rates and determine the probable risk factors affecting femoral catheter survival.

Methods

All 79 tunneled femoral catheters created in our hospital from 2017 to 2020 were included in this study. Patients having no other means for dialysis access other than the femoral catheter was recruited in this study. Data collected included patient age, sex, comorbidities (diabetes and hypertension), transplant history, dialysis duration, catheter complications, femoral access history, and primary and exchanged femoral patency rates. Patients were followed for 4–36 months.

Results

The median catheter primary patency was 7 months (95% confidence interval [CI]: 5.77, 8.22) and the primary patency rates at 2, 4 and 6 months were 79%, 68% and 48%, respectively. The median exchanged catheter survival was 8 months (95% CI: 0.83, 15.17) and the exchanged patency rates at 1, 3 and 8 months were 72%, 64% and 32%, respectively. Of the patients (n = 62), 8% (5 patients) died because they had no other option for dialysis access.

Conclusion

Tunneled femoral catheters have a low patency rate and should be the last option for haemodialysis patients when other probable accesses are not available.

Hereditary thrombophilia and thrombosis of tunneled hemodialysis catheters: A single center study

Introduction: Vascular access thrombosis increases the risk of mortality and morbidity in end-stage renal disease (ESRD) patients on hemodialysis (HD). This study aimed to evaluate hereditary thrombophilia factors in HD patients and its association with tunneled cuffed catheters’ thrombosis.

Methods: In this cross-sectional study, 60 consecutive patients with ESRD on HD with tunneled cuffed catheters were selected. Inherited thrombophilia factors (Anti-thrombin III, Protein C, Protein S, and Factor V Leiden) were measured and the patients were followed for 3 months to evaluate the incidence of catheter-related thrombosis. The association between these factors and catheter thrombosis was assessed.

Results: The mean age of patients was 60.30 ± 8.69 years. Forty-seven patients (78.30%) were female and thirteen patients (21.70%) were male. The most common cause of ESRD was diabetes mellitus (41.67%). The most catheter site was the right internal jugular vein (55%). There were 22 (36.67%) and 8 (13.33%) cases of thrombosis and mortality, respectively. The association between hereditary thrombophilia factors and catheter thrombosis was not statistically significant (P > 0.05).

Conclusion: In this small group of our patients, the frequency of hereditary thrombophilia was not significantly different between those with and without thrombosis of tunneled HD catheter.