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.

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.

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.

A Laparoscopic Approach under Local Anesthesia for Peritoneal Dialysis Access

2000 ◽  
Vol 20 (6) ◽  
pp. 757-765 ◽  
Author(s):  
John H. Crabtree ◽  
Arnold Fishman
Keyword(s):  
Peritoneal Dialysis ◽  
Local Anesthesia ◽  
Rectus Sheath ◽  
Laparoscopic Approach ◽  
Dialysis Access ◽  
Catheter Survival ◽  
Simultaneous Identification ◽  
Port Device ◽  
Port Location

Objective Presented herein is a technical description of a time-proven laparoscopic approach to establishing successful long-term peritoneal dialysis access. Design Using a two-port technique, the peritoneal catheter is inserted through a paramedian port site while continuously monitoring the implant procedure with a laparoscope from a second port location. A long rectus sheath tunnel created with a nontrocar port device keeps the dialysis catheter oriented toward the pelvis. Helium abdominal insufflation enables full surgical laparoscopy under local anesthesia. Validation of the effectiveness of the technique is made by comparison to previous implantation experience using an open dissection method. Patients Laparoscopic implantation of peritoneal catheters was performed in 150 patients, and placement by open dissection was accomplished in 63 patients. Main Outcome Measure The incidence of complications and revision-free catheter survival between implantation methods were compared. Results Catheters implanted laparoscopically had a significantly lower incidence of flow dysfunction ( p < 0.05) and better survival ( p < 0.001) than those placed by open dissection. Conclusions Compared to implantation by open dissection, the laparoscopic approach provides the patient reduced perioperative discomfort. The procedure can be performed safely with the patient under local anesthesia on an ambulatory basis. Laparoscopic implantation significantly reduces the incidence of catheter flow dysfunction and permits simultaneous identification and correction of other problems that could complicate dialysis therapy.

Approach to Vascular Access for Hemodialysis: Experiences from the Republic of Macedonia

2002 ◽  
Vol 25 (5) ◽  
pp. 354-364 ◽  
Author(s):  
A. Oncevski ◽  
P. Dejanov ◽  
V. Gerasimovska ◽  
M.H. Polenakovic
Keyword(s):  
Vascular Access ◽  
Vascular Grafts ◽  
Original Method ◽  
Late Complications ◽  
Dialysis Access ◽  
Arteriovenous Anastomosis ◽  
Jugular Veins ◽  
Femoral Catheterization ◽  
Venous Fistula ◽  
Stage Renal Disease

Eight thousand eight hundred and forty nine different vascular hemodialysis accesses were performed in the period from 1976 until 1999 at the Department of Nephrology, Skopje: 3,114 native arterial-venous fistula (AVF), 715 arterial-venous shunts (AVS), 4,964 temporary or permanent catheters (4,411/88.86% femoral, 410/8.26% subclavian, 143/2.88% jugular) and 56 PTFE vascular grafts. Femoral catheterization (4,312/86.86%) is the favoured solution if a temporary vascular dialysis access is taken into consideration. The most popular chronic dialysis angio-access in our country is native AVF (90.5% of 3,440 permanent dialytic vascular accesses). The tunneled subcutaneously positioned catheters as a permanent dialytic angio-access were present in 270 cases (7.9%): 99 in femoral veins (our original method), 123 in subclavian veins and 48 catheters in jugular veins. The synthetic vascular grafts-PTFE (polytetrafluoro-ethylene) represent only 1.6% of all dialysis angio-accesses. The number of preventive AVFs created in patients with preterminal end-stage renal disease eventually increased; from 14% in the eighties, 20.8% after 10 years and 31.50% in 1999. Most of the preventive AVFs are done in outpatients 71.8% in 1999. This year 44.4% of all chronic vascular access were created in the same way. We prefer femoral catheters for both temporary and permanent access because our results show that femoral catheterization has a lower rate of early complications when compared to the subclavian catheterization group; the rate of late complications (thrombosis, stenosis, infections) is lower or the same; infections in femoral catheterizations are less frequent, compared to subclavian and jugular ones. Our contributions in the field of vascular access surgery are the three original methods which are constantly used at the Department: 1. Combination of temporary (AVS) and permanent vascular access (AVF) using the same blood vessels, performed in one surgical act; 2. Tunneled femoral catheter as a permanent vascular access for hemodialysis (2 types: on the abdominal wall and on the infrainguinal region - thigh); 3. Reduction of hyper-flow in AVF without the operation of “banding”, with ligation of the artery before arteriovenous anastomosis.

Tertiary nitrification in pilot-plant plug-flow fixed-film reactors with long-term ammonium deficiency

1994 ◽  
Vol 29 (10-11) ◽  
pp. 61-67 ◽  
Author(s):  
M. Fruhen ◽  
K. Böcker ◽  
S. Eidens ◽  
D. Haaf ◽  
M. Liebeskind ◽  
...  
Keyword(s):  
Pilot Plant ◽  
Effective Means ◽  
Plug Flow ◽  
Nitrification Rate ◽  
Industrial Project ◽  
Transfer Processes ◽  
Fixed Film ◽  
Film Reactor ◽  
Observation Period

The objective of this study is to investigate to what extent the nitrification capacity of a pilot-plant fixed-film reactor changes during extensive periods of nutrient supply deficiency. The examined pilot-plant was an upflow reactor filled with swelling clay of medium grain size (6 to 8 mm). The experiments revealed that the maximum nitrification rate remained practically constant during the first weeks after the onset of unregulated ammonium supply. The capacity declined slowly, dropping to approximately 66% of the initial capacity after about ten weeks. Still ammonium peaks of up to 8 mg/l were readily nitrified throughout the entire period of the experiment. The reduction in nitrification capacity during the observation period did not result from decay processes of biomass but from the reactor becoming blocked and thus hampering transfer processes. It could be observed that the detached organisms attached again further up. This semi-industrial project demonstrated that a plug-flow fixed-film reactor can be used as effective means of tertiary nitrification.

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