Cuffed-tunneled Femoral Catheter for Long-term Hemodialysis

2001 ◽  
Vol 24 (7) ◽  
pp. 443-446 ◽  
Author(s):  
K.M. Chow ◽  
C.C. Szeto ◽  
C.B. Leung ◽  
T. Y.H. Wong ◽  
P.K.T. Li
Keyword(s):  
Blood Flow ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Upper Extremities ◽  
Rank Test ◽  
Dialysis Access ◽  
Ptfe Graft ◽  
Risk Of Infection ◽  
Femoral Catheter

Background Hemodialysis access is a challenging problem in patients with exhausted dialysis access sites of their upper extremities. Femoral arterio-venous polytetrafluoroethylene (PTFE) graft is often necessary. The safety and efficacy of cuffed tunneled catheters at the femoral site for long-term hemodialysis has not been extensively studied. Methods We inserted 14 cuffed-tunneled femoral catheters in 11 hemodialysis patients with exhausted dialysis access sites of their upper extremities. Access survival and risk of infection were compared with the 11 femoral PTFE grafts in 10 patients of our center during the same period. The choice of dialysis access was determined by the individual nephrologist. Access survival was defined as the achievement of a blood flow rate of at least 180 ml/min. Results The median survival of tunneled femoral catheter and PTFE graft were 166 days and 560 days respectively (log-rank test, p = 0.33). Seven of the 14 tunneled femoral catheter remained in use 3 months after insertion. The incidence of catheter- or graft-related infection was 0.38 and 0.23 episodes per 100 catheter / graft days for tunneled femoral catheters and PTFE graft respectively (p = 0.6). Five tunneled catheters and one PTFE graft had to be removed because of infection. Blood flow rates achieved were comparable between tunneled femoral catheter and PTFE graft. Conclusions Our preliminary data suggest that the cuffed tunneled femoral catheter has reasonable access survival and an acceptable risk of infection. It may provide a safe and effective access for long-term hemodialysis patients with exhausted access in their upper extremities, especially high risk patients who are not suitable for femoral PTFE graft creation.

scholarly journals Application of Non-thermal Commscope Irradiation in Preventing Com- plications of Hemodialysis Fistula

1970 ◽  
Vol 1 (1) ◽  
Author(s):  
Leng Hui
Keyword(s):  
Blood Flow ◽  
Blood Vessel ◽  
Arteriovenous Fistula ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
First Choice ◽  
Long Time ◽  
And Control

Abstract: Objective: To ensure that the patient’s treatment and control of the patient’s blood in the course of long-term dialysis, in order to ensure the blood flow rate at the rate of hemodialysis in the blood vessel of hemodialysis patients, mortality rate. Methods: In many Western countries, it has been found from the experience of long-term accumulation, arteriovenous fistula (AVF) is the first choice for long-term dialysis blood patients, which has a lot of a little bit, not only from the infection rate and blood flow, which has a lot of advantages.But its existence is also a lot of complications, non-thermal Commscope irradiation is a very effective way. Results: The method was compared with the method, and it was found that P <0.05, which was statistically significant. Conclusion: AVF is the preferred method of vascular access in patients with persistent dialysis, which is very easy to be punctured and has a very long time for maintenance. It is very important to carry out the treatment, treatment and surveillance of AVF complications and the use of means.

Long-term results of thigh arteriovenous dialysis grafts

2018 ◽  
Vol 20 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Denise Kim ◽  
Cynthia Bhola ◽  
Naomi Eisenberg ◽  
Janice Montbriand ◽  
George Oreopoulos ◽  
...  
Keyword(s):  
Standard Error ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Upper Extremities ◽  
Long Term Results ◽  
High Infection Rate ◽  
Cumulative Proportion ◽  
High Infection ◽  
Arteriovenous Access

Introduction: A proportion of hemodialysis patients exhaust all options for arteriovenous access in upper extremities. Arteriovenous thigh grafts are a potential vascular access option in such patients. Methods: We performed a retrospective study of all thigh arteriovenous access grafts placed between 1995 and 2015. The clinical, demographic patient information and patency of each thigh graft was determined from the time of surgical creation placement until abandonment, transfer to other modality, or center or end of study, and the reason for access failure documented. Results: In total, 44 patients received 49 thigh arteriovenous accesses. The average age was 60 years (13–79 years); Half (53%) of the patients (n = 24) were female and 61% of the patients (n = 30) of arteriovenous accesses were left-sided. The cumulative proportion surviving (primary patency rates) at 12, 24, and 28 months were 43% (standard error = 9%), 33% (standard error = 9%), and 13% (standard error = 9%), respectively. The cumulative proportion of surviving grafts at 12, 24, and 48 months were 61% (standard error = 8%), 58% (standard error = 9%), and 31% (standard error = 13%), respectively. In total, 37 revisions were performed in 22 patients to maintain patency or eradicate infection. Infection occurred in 20 patients (39%) of thigh grafts requiring 16 patients (80% of those affected) to be removed; 14 patients had grafts (33.3%) that served as the lone hemodialysis arteriovenous access during the patients’ lifetime on dialysis. Conclusion: Arteriovenous thigh graft access is used infrequently, but they have an acceptable patency. Some accesses require revisions and they have a high infection rate. Despite this, an acceptable proportion of leg grafts provide durable access for the dialysis lifetime of the patient.

Predicting arterio-venous fistula failure by urea–method derived access blood flow in chronic hemodialysis patients

2020 ◽  
Vol 21 (6) ◽  
pp. 1011-1016
Author(s):  
Kumtorn Lelamali ◽  
Piyarek Papirachanat ◽  
Thitiya Puavilai
Keyword(s):  
Blood Flow ◽  
Characteristic Curve ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Interquartile Range ◽  
Dialysis Access ◽  
Ultrasound Dilution ◽  
Limb Edema ◽  
Venous Fistula ◽  
Urea Method

Background: Dialysis access is an essential part of hemodialysis. Determining the access blood flow (Qa) can help predict arterio-venous fistula thrombosis. Qa determination by the urea method, which was previously described in the past is simple and is available in most of the dialysis units but was not be able to predict arterio-venous fistula thrombosis. Aim: To compare the efficacy of Qa determination by the urea method and by ultrasound dilution methods in predicting arterio-venous fistula failure. Methods: Qa was measured by urea method and by ultrasound dilution simultaneously, every 3 months for a period of 1 year, in stable chronic hemodialysis patients with arterio-venous fistula. Arterio-venous fistula failure determined by clinical parameters and confirmed by Doppler ultrasound before sending the patient for interventional angioplasty. Results: This study enrolled a total of 16 patients, with 63% being male, 75% with lower-arm arterio-venous fistula and around 43% with previously done angioplasty. 59-Qa measurements were done, and 6 patients underwent angioplasty (one patient for severe upper limb edema, one for access thrombosis, and four for access dysfunction). Qa determination by the urea method had non-significantly lower Qa, (745 mL/min (interquartile range: 509–1143) and 779 mL/min (interquartile range: 530–1160), (p = 0.58)) and high correlation (r = 0.83, p < 0.001) to Qa by ultrasound dilution. The cut-off criteria with its sensitivity and specificity in predicting the access failure were 440 mL/min, 66.67%, and 96.15% for Qa determination by the urea and 400 mL/min, 66.67% and 90.38% for Qa by ultrasound dilution, respectively, with no difference in the area under the receiver operating characteristic curve. Conclusion: Measurement of Qa determination by the urea method is well correlated with Qa by ultrasound dilution and can be used to predict vascular access failure.

Blood Flow Rate and Access Recirculation in Hemodialysis

1992 ◽  
Vol 15 (8) ◽  
pp. 470-474 ◽  
Author(s):  
I.D. Daniels ◽  
G.M. Berlyne ◽  
R.H. Barth
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Blood Pump ◽  
Concomitant Increase ◽  
Urea Clearance ◽  
Extracorporeal Blood

We studied the effect of extracorporeal blood flow rate (BFR) on access recirculation (recirc) in 19 hemodialysis patients. BUN was determined in simultaneous peripheral (P), arterial (A), and venous (V) blood obtained at BFRs of 200, 400 and 600 ml/min. Percent recirc was calculated for each BFR using the formula (P-A) / (P-V) X 100. Venous drip-chamber (VP) and pre-blood-pump (AP) pressures were measured at each BFR. Fistulograms were performed in 10 patients, and stenoses were identified in 5, all at the proximal (arterial) end of the access. Recirc increased with increasing BFR from 200 to 400 ml/min but increased little from 400 to 600 ml/min. At all BFRs recirc in the stenotic patients was higher than that of non-stenotic or unstudied patients. Urea clearance, corrected for recirc, rose with blood flow both in stenotic and non-stenotic patients. There were no differences in AP or in VP between stenotic and non-stenotic patients. At BFR ≥ 400 ml/min, a recirc threshold of 15% identified stenoses with sensitivity 100% and specificity 71%. We conclude (1) recirc increases with increasing BFR but not enough to outweight the concomitant increase in urea clearance; (2) significant access stenosis and recirc may be present even with low VP; (3) recirc was associated with arterial side stenoses; (4) at BFR ≥ 400 ml/min, access stenosis is associated with recirc > 15%.

Prescribing Dialysate Bicarbonate Concentrations for Hemodialysis Patients

1988 ◽  
Vol 11 (1) ◽  
pp. 45-50 ◽  
Author(s):  
F.G. Heineken ◽  
M. Brady-Smith ◽  
J. Haynie ◽  
J.C. Van Stone
Keyword(s):  
Blood Flow ◽  
Blood Flow Rate ◽  
Baseline Period ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Bicarbonate Concentration ◽  
Acid Base ◽  
Ultrafiltration Rate ◽  
Plasma Bicarbonate ◽  
Normal Acid

A rearranged equation of Sargent and Gotch (1) was used to determine dialysate bicarbonate concentrations for hemodialysis patients. Parameters in this equation include an estimate of the acid generated by each patient between treatments, an estimate for the dialyzer dialysance for bicarbonate, ultrafiltration rate, blood flow rate and a targeted mid-dialysis plasma bicarbonate concentration of 25 mEq/L. Nine patients were studied over a 35 week period to verify this method of determining each patient's dialysate bicarbonate concentration. Prescribed dialysate bicarbonate concentrations for the nine patients varied from 29 to 38 mEq/L with five patients having a prescribed value of 35 mEq/L. After a baseline period of five weeks, five patients switched from a 37 mEq/L acetate dialysate to their prescribed dialysate bicarbonate concentration. Four patients who had already been on bicarbonate dialysis at a concentration of 35 mEq/L were dialyzed with their prescribed dialysate bicarbonate concentrations. Patients were then followed for a study period of 30 weeks. The prescribed dialysate bicarbonate concentration resulted in more normal acid/base chemistries for both groups of patients. The results also demonstrate that chronic hemodialysis patients require individualization of dialysate bicarbonate concentrations.

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

2018 ◽  
Vol 47 (1-3) ◽  
pp. 132-139
Author(s):  
Gerardo Guillermo-Corpus ◽  
Jesus Manolo Ramos-Gordillo ◽  
José Carlos Peña-Rodríguez
Keyword(s):  
Blood Flow ◽  
Clinical Outcomes ◽  
Infection Rate ◽  
Vascular Access ◽  
Lower Extremities ◽  
Hemodialysis Patients ◽  
Low Risk ◽  
Risk Of Infection ◽  
Upper And Lower Extremities

Background: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts. Material and Methods: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. Results: The survival of the tunneled catheters was 771 days 95% CI (737–805) for jugular and 660 days 95% CI (582–739) for femoral veins. Blood flow (0.292 ± 0.003 L/min) and infection rate (0.25 × 1,000 days/catheter) were similar for upper and lower extremities vascular accesses. Factors including sex, age, diabetes and previous catheters did not affect the outcome. Conclusions: Femoral catheters provide outstanding vascular access with excellent, function and low risk of infection.

The Effect of Increasing Blood Flow Rate on Severity of Uremic Pruritus in Hemodialysis Patients: A Single Clinical Trial

2018 ◽  
Vol 110 (3) ◽  
pp. 270-275 ◽  
Author(s):  
Mansooreh Aliasgharpour ◽  
Soheila Zabolypour ◽  
Ahmadali Asadinoghabi ◽  
Hamid Haghani ◽  
Mahboub Lesanpezeshki
Keyword(s):  
Clinical Trial ◽  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Uremic Pruritus

Survival of tunneled hemodialysis catheters after percutaneous placement.

2016 ◽  
Vol 63 (1) ◽  
Author(s):  
Ewa Weber ◽  
Tomasz Liberek ◽  
Wojciech Wołyniec ◽  
Marcin Gruszecki ◽  
Bolesław Rutkowski
Keyword(s):  
Older Patients ◽  
Mechanical Damage ◽  
Hemodialysis Patients ◽  
Late Complications ◽  
Dialysis Access ◽  
Patient Death ◽  
Catheter Survival ◽  
Venous Fistula ◽  
Observation Period

Tunneled catheters are becoming increasingly used as a permanent dialysis access. Easy way of insertion and good long-term patency make them competitive to fistulas in some groups of patients. Late complications and survival of 180 tunneled catheters inserted from June 2010 to December 2013 in 171 unselected hemodialysis patients were analyzed. The cumulative time of observation was 2103.5 patient-months and median observation was 9 months (range of 0.5-45 months). Only 19 out of 180 catheters were removed due to complications (12 for infections, 4 due to malfunction and 3 because of mechanical damage). Majority of catheters were removed electively: 27 after maturation of arterio-venous fistula (AVF), 4 after kidney transplant, 5 after transfer to peritoneal dialysis and 3 due to the recovery of renal function. At the end of the observation, 58 catheters were still in use and 64 patients had died with functioning catheter. When censored for elective catheter removal and patient death, 88.2% of catheters survived for 1 year. Catheter survival was significantly better in older patients (over 65 years, in comparison to patients < 65 years, p = 0.046). Nearly 90% of all inserted catheters gave reliable dialysis access as long as it was needed. Among them, over 30% of the inserted catheters were in use at the end of the observation period, and over 30% of patients had died with a functioning catheter. The results of tunneled catheters survival are encouraging and they should be taken into consideration during decision-making on vascular access, especially in the older patients.

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