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Central venous catheter dialysis

Parnandi Bhaskar Rao, Neha Singh, Sumanth Samson
A 56-year-old man on maintenance hemodialysis was admitted to the intensive care unit with septic shock and coagulopathy. As there was a dialysis catheter in the right internal jugular vein, the left internal jugular vein was cannulated with a central venous catheter to initiate vasopressor therapy. A chest X-ray showed formation of a catheter loop inside the left brachiocephalic vein, probably due to hindrance by the dialysis catheter. This report describes the hurdles encountered, repeated cannulation attempts, and serial chest X-ray findings required to obtain acceptable placement of the catheter tip...
October 2016: Korean Journal of Anesthesiology
Adam D Jakes, Poonam Jani, Victoria Allgar, Archie Lamplugh, Ahmed Zeidan, Sunil Bhandari
BACKGROUND: Dialysis in elderly patients (>80-years-old) carries a poor prognosis, but little is known about the most effective vascular access method in this age group. An arteriovenous fistula (AVF) is both time-consuming and initially expensive, requiring surgical insertion. A central venous catheter (CVC) is initially a cheaper alternative, but carries a higher risk of infection. We examined whether vascular access affected 1-year and 2-year mortality in elderly patients commencing haemodialysis...
2016: PloS One
Dr Charlotte Ratcliff, Miss Monica Hansrani
INTRODUCTION: This case report intends to highlight the Haemodialysis Reliable Outflow (HeRO) graft as a potential long term option for ongoing dialysis in patients with central venous stenosis. PRESENTATION OF CASE: A 55year old patient, who developed end stage renal failure (ESRF) after chemotherapy treatment for breast cancer, presented at the limit of her dialysis access after a 15year haemodialysis history causing central vein stenosis. The patient was initially started on peritoneal dialysis but after repeated peritonitis was switched to haemodialysis...
2016: International Journal of Surgery Case Reports
E Mancini, C Perazzini, L Gesualdo, F Aucella, A Limido, F Scolari, S Savoldi, M Tramonti, L Corazza, M Atti, S Severi, P Bolasco, A Santoro
BACKGROUND: Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM: To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH...
August 29, 2016: Journal of Nephrology
Mauro Pittiruti, Sergio Bertoglio, Giancarlo Scoppettuolo, Roberto Biffi, Massimo Lamperti, Alberto Dal Molin, Nicola Panocchia, Nicola Petrosillo, Mario Venditti, Carla Rigo, Enrico DeLutio
BACKGROUND: The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT - the Italian group for venous access devices - has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters). METHOD: After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients...
August 1, 2016: Journal of Vascular Access
Eric Salazar, Salvador Garcia, Robin Miguel, Francisco J Segura, Tina S Ipe, Christopher Leveque
Therapeutic and donor apheresis requires adequate vascular access to achieve inlet flow rates of ∼50-100 mL/min. While central dialysis-type venous catheters can usually provide such access, their use includes several associated risks. Some of these risks can be avoided or diminished if adequate peripheral venous access can be established. Some patients have adequate peripheral veins for apheresis that cannot be readily identified visually or by palpation. We hypothesized that ultrasound-guided peripheral venous access would benefit such patients and would lead to placement of fewer central venous catheters...
August 10, 2016: Journal of Clinical Apheresis
Vinay Narasimha Krishna, Joseph B Eason, Michael Allon
Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS...
August 1, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
I-Kuan Wang, Te-Chun Shen, Chih-Hsin Muo, Tzung-Hai Yen, Fung-Chang Sung
BACKGROUND: This study compared the pulmonary embolism (PE) risks between Asian dialysis patients and a comparison cohort without clinical kidney disease. METHODS: From the National Health Insurance claims data of Taiwan, we identified 106 231 newly diagnosed end-stage renal disease patients undergoing dialysis in 1998-2010 and randomly selected 106 231 comparison subjects, frequency matched by age, sex and the index year. We further selected 7430 peritoneal dialysis (PD) patients and 7340 propensity score-matched hemodialysis (HD) patients...
July 22, 2016: Nephrology, Dialysis, Transplantation
Decenzio Bonucchi, Lucia Palmieri, Silvia Arletti, Gianni Cappelli, Carlo Lomonte, Massimo Lodi, Mario Meola, Monica Spina, Marcello Napoli
PURPOSE: Dialysis settings have generally improved over the last decades, but the vascular access setting did not see significant advances and experienced a progressive worsening in epidemiology and clinical features. The aim of the study was to describe and compare evolution of vascular access in Italy over time. METHODS: A national survey implemented in Italy last year is presented and compared to a previous survey performed in 1998. Present survey collected data from almost 50% of centers involved in vascular access...
September 21, 2016: Journal of Vascular Access
Anil K Agarwal, Stephen R Ash
Introduction Chronic central venous catheters (CVC) for dialysis lose patency and deliver lower blood flow over time, often due to fibrous sheathing that covers the lumen tips. The CentrosFLO central venous catheter has a shape that directs the arterial and venous tips away from the walls of the vena cava and right atrium, making sheathing of the tips less likely. Methods A prospective, multicenter, single arm, non-controlled, observational study was conducted at eight sites in the United States. All consenting dialysis patients receiving CentrosFLO catheters through the right or left internal jugular veins were accepted in the study, as long as the catheter was expected to be used for 45 days and was not an over-the-wire replacement for a previous CVC...
June 27, 2016: Hemodialysis International
Gregor Novljan, Rina R Rus, Vladimir Premru, Rafael Ponikvar, Nina Battelino
When peritoneal dialysis is inapplicable, chronic hemodialysis (HD) becomes the only available treatment option in small children. Due to small patient size, central venous catheters (CVC) are mainly used for vascular access. Over the past 4 years, four children weighing less than 15 kg received chronic HD in our unit. A total of 848 dialysis sessions were performed. Altogether, 21 catheters were inserted. In all but one occasion, uncuffed catheters were used. Catheter revision was performed 15 times during the study period, either due to infection or catheter malfunction...
June 2016: Therapeutic Apheresis and Dialysis
William C Jennings, Donald E Parker
PURPOSE: An arteriovenous fistulas (AVF) is the preferred vascular access for hemodialysis and is associated with lower mortality, morbidity and cost when compared with grafts and particularly with central venous dialysis catheters. This study reviews a series of new patients where an autogenous access was constructed for each individual utilizing surgeon-performed ultrasound (SP-US). METHODS: Consecutive new patients referred for a permanent vascular access during an 11-year period were retrospectively reviewed...
July 12, 2016: Journal of Vascular Access
Leyat Tal, Joseph R Angelo, Ayse Akcan-Arikan
Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults...
November 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Spencer Galt, Mark Crawford, John Blebea, Eric Ladenheim, Barry Browne
BACKGROUND: The Venous Window Needle Guide (VWING; Vital Access Corp, Salt Lake City, Utah) is a surgically implanted titanium device designed to facilitate cannulation of uncannulatable dialysis access arteriovenous fistulas (AVFs) because of excessive depth, aneurysm formation, or tortuosity but that exhibit sufficient flow volume to support hemodialysis. We report the 18-month fistula patency, functionality, and complications of the use of the VWING device. METHODS: This retrospective study examined AVF patency, VWING functionality, interventions, and device infections at 18 months after VWING implantation...
September 2016: Journal of Vascular Surgery
Vishal B Parekh, Vandana D Niyyar, Tushar J Vachharajani
Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access...
September 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Maarten Wester, Karin G Gerritsen, Frank Simonis, Walther H Boer, Diënty H Hazenbrink, Koen R Vaessen, Marianne C Verhaar, Jaap A Joles
BACKGROUND: Patients on standard intermittent haemodialysis suffer from strong fluctuations in plasma potassium and phosphate. Prolonged dialysis with a wearable device, based on continuous regeneration of a small volume of dialysate using ion exchangers, could moderate these fluctuations and offer increased clearance of these electrolytes. We report in vivo results on the efficacy of potassium and phosphate adsorption from a wearable dialysis device. We explore whether equilibration of ion exchangers at physiological Ca(2+), Mg(2+) and hypotonic NaCl can prevent calcium/magnesium adsorption and net sodium release, respectively...
May 24, 2016: Nephrology, Dialysis, Transplantation
Gerald A Beathard
The nonmaturing arteriovenous fistula (AVF) is a major problem and can lead to significant patient morbidity and mortality because the patient is exposed to the risk of dialysis with a central venous catheter (CVC). Access planning should include a strategy to decrease the incidence of AVF nonmaturation. All newly created AVFs should be evaluated for maturation at 4-6 weeks. If it is judged to not be usable at that time, it should be evaluated for salvage. However, if multiple procedures over a prolonged period of time are necessary for salvage, the decreasing chances of long-term success with the increasing risks of CVC-based dialysis must be considered...
July 2016: Seminars in Dialysis
Michiel B Winkes, Maarten J Loos, Marc R Scheltinga, Joep A Teijink
PURPOSE: We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion. METHOD AND RESULTS: An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation...
2016: Journal of Vascular Access
Branko Fila, Saša Magaš, Predrag Pavić, Renata Ivanac, Marko Ajduk, Marko Malovrh
Access to the circulation is an "Achilles' heel" of chronic hemodialysis. According to the current guidelines, autologous arteriovenous fistula is the best choice available. However, the impossibility of immediate use and the high rate of non-matured fistulas place fistula far from an ideal hemodialysis vascular access. The first attempt at constructing an angioaccess should result in functional access as much as possible. After failed attempts, patients and nephrologists lose their patience and confidence, which results in high percentage of central venous catheter use...
September 2016: International Urology and Nephrology
Wenbo Zhang, Tao Liu, Xinling Wang, Yanhong Huo, Yingmin Jia, Li Su, Yuanyuan Liu
Central venous catheters (CVC) are widely used in clinics to gain vascular access, but the risk and prevalence of catheter-related complications remains a serious issue. We report a long-term dialysis catheter accidentally inserted into the mediastinum via the right jugular vein in a hemodialysis patient. We also review complications associated with vascular catheterization and propose immediate therapeutic interventions for such cases.
May 16, 2016: Hemodialysis International
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