Vascular Access Placement Order and Outcomes in Hemodialysis Patients: A Longitudinal Study

2017 ◽  
Vol 46 (4) ◽  
pp. 268-275 ◽  
Author(s):  
Mariana Murea ◽  
W. Mark Brown ◽  
Jasmin Divers ◽  
Shahriar Moossavi ◽  
Todd W. Robinson ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Vascular Access ◽  
Conversion Rate ◽  
Hemodialysis Patients ◽  
Central Venous Catheters ◽  
Failure Rates ◽  
Transition Rates ◽  
Central Venous ◽  
Av Fistulas

Background: Arteriovenous accesses (AVA) in patients performing hemodialysis (HD) are labeled “permanent” for AV fistulas (AVF) or grafts (AVG) and “temporary” for tunneled central venous catheters (TCVC). Durability and outcomes of permanent vascular accesses based on the sequence in which they were placed or used receives little attention. This study analyzed longitudinal transitions between TCVC-based and AVA-based HD outcomes according to the order of placement. Methods: All 391 patients initiating chronic HD via a TCVC between 2012 and 2013 at 12 outpatient academic dialysis units were included in this study. Chronological distributions of HD vascular accesses were recorded over a mean (SD) of 2.8 (0.9) years and sequentially grouped into periods for TCVC-delivered and AVA-delivered (AVF or AVG) HD. Primary AVA failure and cumulative access survival were evaluated based on access placement sequence and type, adjusting for age. Results: In total, 92.3% (361/391) of patients underwent 497 AVA placement surgeries. Analyzing the initial 3 surgeries, primary AVF failure rates increased with each successive fistula placement (p = 0.008). Among the 82.9% (324/391) of TCVC patients successfully converted to an AVA, 30.9% returned to a TCVC, followed by a 58.0% conversion rate to another AVA. Annual per-patient vascular access transition rates were 2.02 (0.09) HD periods using a TCVC and 0.54 (0.03) HD periods using an AVA. Comparing the first AVA used with the second, cumulative access survivals were 701.0 (370.0) vs. 426.5 (275.0) days, respectively. Excluding those never converting to an AVF or AVG, 169 (52.2%) subsequently converted from a TCVC to a permanent access and received HD via AVA for ≥80% of treatments. Conclusions: HD vascular access outcomes differ based on the sequence of placement. In spite of frequent AVA placements, only half of patients effectively achieved a “permanent” vascular access and used an AVA for the majority of HD treatments.

scholarly journals Vascular access for hemodialysis: Current practice in Vietnam

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 20-23 ◽  
Author(s):  
Long Duc Dinh ◽  
Dung Huu Nguyen
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Central Venous Catheters ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Central Venous ◽  
Advanced Country

A well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure, which directly affects the quality of life in hemodialysis patients. We use three main types of access: native arteriovenous fistula, arteriovenous graft, and central venous catheter. Arteriovenous fistula remains the first and best choice for chronic hemodialysis. It is the best access for longevity, the lowest related complications, and for this reason, arteriovenous fistula use is strongly recommended by guidelines from different countries, including Vietnam. In practice, well-functioning arteriovenous fistula creation is not always simple. In this case, arteriovenous fistula creation with vein transposition or translocation is certainly useful. When native vein options have been exhausted, prosthetic can be used as the second option of maintenance hemodialysis access alternatives. Central venous catheters are very common and have become an important adjunct in maintaining patients on hemodialysis. In Bach Mai hospital, we certainly create about 1000 new arteriovenous fistulas every year (among these, about 84.98% new hemodialysis patients start hemodialysis without permanent accesses and depend on temporary central venous catheters) and successfully matured arteriovenous fistula rate is 92.6%. Among hemodialysis population in Bach Mai, 2.29% have arteriovenous grafts and 2.81% of patients still depend on cuffed tunneled catheters. The preferable locations for catheter insertions are the internal jugular and femoral veins. Proper vascular access maintenance requires integration of different professionals to create a vascular access team. Percutaneous transluminal angioplasty is not available. In our circumstance, we have achieved some advantages for hemodialysis patients but still a big gap to an advanced country.

A Stuck Hemodialysis Central venous Catheter

2008 ◽  
Vol 9 (4) ◽  
pp. 301-303 ◽  
Author(s):  
M. Field ◽  
J. Pugh ◽  
J. Asquith ◽  
S. Davies ◽  
A.D. Pherwani
Keyword(s):  
Case Report ◽  
Central Venous Catheter ◽  
Vascular Access ◽  
Insertion Site ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Central Venous Catheters ◽  
Central Venous

Background A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. Case report We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. Discussion The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.

Optimizing vascular-access device decision-making in the era of midline catheters

2019 ◽  
Vol 40 (6) ◽  
pp. 674-680 ◽  
Author(s):  
Kelly A. Cawcutt ◽  
Richard J. Hankins ◽  
Teresa A. Micheels ◽  
Mark E. Rupp
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Vascular Access ◽  
Central Venous Catheters ◽  
Narrative Review ◽  
Central Venous ◽  
Access Device ◽  
Vascular Access Device ◽  
Intravenous Catheters

AbstractThis narrative review addresses vascular access device choice from peripheral intravenous catheters through central venous catheters, including the evolving use of midline catheters. The review incorporates best practices, published algorithms, and complications extending beyond CLABSI and phlebitis to assist clinicians in navigating complex vascular access decisions.

Pitfall in Pediatric Dialysis: Malposition of a Dialysis Catheter Mimicking Azygos Continuation Syndrome

2007 ◽  
Vol 8 (4) ◽  
pp. 302-304 ◽  
Author(s):  
A.W. Demant ◽  
H. Rattunde ◽  
S. Abderhalden ◽  
R. Von Vigier ◽  
R.W. Wolf
Keyword(s):  
Vascular Access ◽  
Dialysis Patient ◽  
Azygos Vein ◽  
Central Venous Catheters ◽  
Dialysis Catheter ◽  
Central Venous ◽  
Pediatric Dialysis ◽  
Vein System ◽  
Azygos Continuation ◽  
Catheter Malposition

Central venous catheters are established as vascular access in hemodialysis therapy. Vascular catheter misdirection may occur and is a well known problem. We present a rare catheter malposition in a young dialysis patient with consequent dilatation of the azygos vein system, simulating the appearance of an azygos continuation syndrome (ACS).

Improved Vascular Access for Patients Receiving Chemotherapy

1983 ◽  
Vol 28 (2) ◽  
pp. 138-140 ◽  
Author(s):  
C. Porteous ◽  
J. Welsh ◽  
Aileen Keel ◽  
Joanne C. Willox ◽  
H. J. G. Burns
Keyword(s):  
Parenteral Nutrition ◽  
Vascular Access ◽  
Complication Rate ◽  
Chemotherapeutic Agents ◽  
Central Venous Catheters ◽  
Blood Products ◽  
Central Venous ◽  
Oncology Patients ◽  
Venous Cannula

Indwelling central venous catheters were used for vascular access in 25 oncology patients, The lines were used for sampling, administration of blood products, chemotherapeutic agents, parenteral nutrients and occasionally plasmapheresis. The complication rate was no higher than in reported series in which the catheters were reserved for parenteral nutrition. We believe that a central venous cannula can be safely used as the sole means of vascular access in those patients with consequent psychological and practical benefits.

scholarly journals Using Cuffed and Tunnelled Central Venous Catheters as Permanent Vascular Access for Hemodialysis: A Prospective Study

Renal Failure ◽  
2003 ◽  
Vol 25 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Ramazan Cetinkaya ◽  
Ali Riza Odabas ◽  
Yahya Unlu ◽  
Yilmaz Selcuk ◽  
Azman Ates ◽  
...  
Keyword(s):  
Prospective Study ◽  
Vascular Access ◽  
Central Venous Catheters ◽  
Central Venous ◽  
A Prospective Study
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