Safety of Bedside Placement of Tunneled Hemodialysis Catheters in the Intensive Care Unit: Translating from the COVID-19 Experience

Background: Critically ill patients with coronavirus disease 2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy, typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the intensive care unit who underwent right internal jugular TDC insertion at the bedside between April and December 2020. Outcomes included catheter placement-related complications such as post-procedural bleeding, air embolism, dysrhythmias, pneumothorax/hemothorax, and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform either a single intermittent or 24 h of continuous hemodialysis treatment. Results: We report a retrospective, single-center case series of 25 patients with COVID-19 who had right internal jugular TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore right internal jugular tunneled central venous catheters for infusion. Continuous veno-venous hemodialysis was utilized for kidney replacement therapy in all patients, and a median catheter blood flow rate of 200 mL/min (IQR: 200–200) was achieved without any deviation from the dialysis prescription. No catheter insertion-related complications were observed, and none of the catheter tips were malpositioned. Conclusions: Bedside right internal jugular TDC placement in COVID-19 patients, using ultrasound and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission among healthcare workers without compromising patient safety or catheter function. Concomitant insertion of tunneled central venous catheters in the right internal jugular vein for infusion may also be safely accomplished and further help limit personnel exposure to COVID-19.

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Safety of Bedside Placement of Tunneled Hemodialysis Catheters In The Intensive Care Unit: Translating From The Covid-19 Experience – Retrospective Single-Center Case Series

10.21203/rs.3.rs-762537/v1 ◽

2021 ◽

Author(s):

Mohammad Ahsan Sohail ◽

Tarik Hanane ◽

James Lane ◽

Tushar Vachharajani

Keyword(s):

Intensive Care Unit ◽

Blood Flow ◽

Intensive Care ◽

Case Series ◽

Air Embolism ◽

Fluoroscopic Guidance ◽

Single Center ◽

Anatomic Landmarks ◽

Hemodialysis Catheter ◽

Venous Air Embolism

Abstract Background: Critically-ill patients with coronavirus disease-2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy (KRT), typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit (ICU) to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound (US) and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the ICU who underwent right internal jugular (RIJ) TDC insertion at the bedside between April and December 2020. Outcomes included procedural complications such as bleeding, venous air embolism, arrhythmias, pneumothorax and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform a single hemodialysis treatment. Results: We report a retrospective single-center case series of 25 patients with COVID-19 who had RIJ TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore RIJ tunneled central venous catheters (T-CVC). Continuous veno-venous hemodialysis was the KRT modality employed in all patients. A median catheter blood flow rate of 200 ml/min (IQR:200-200) was achieved in all patients without any deviation from the dialysis prescription. No catheter-related complications were observed and none of the catheter tips were mal-positioned. Conclusions: Bedside RIJ TDC placement in COVID-19 patients, using US and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission amongst healthcare workers without compromising patient safety or catheter function.

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Complications associated with central and non-central venous catheters in a neonatal intensive care unit

Journal of Perinatology ◽

10.1038/jp.2012.7 ◽

2012 ◽

Vol 32 (12) ◽

pp. 941-946 ◽

Cited By ~ 23

Author(s):

K Colacchio ◽

Y Deng ◽

V Northrup ◽

M J Bizzarro

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Central Venous Catheters ◽

Central Venous

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Risk factor identification and predictive models for central line requirements for patients on vasopressors

Anaesthesia and Intensive Care ◽

10.1177/0310057x211024258 ◽

2021 ◽

pp. 0310057X2110242

Author(s):

Adrian D Haimovich ◽

Ruoyi Jiang ◽

Richard A Taylor ◽

Justin B Belsky

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Central Venous Catheter ◽

Single Agent ◽

Composite Endpoint ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

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