Outcomes of Tunneled Dialysis Catheter In Hemodialysis Patients In A Tertiary Care Hospital

BACKGROUND: To evaluate tunnel dialysis catheter (TDC) patency and its outcome among patients receiving TDC in a tertiary care hospital.METHODS: Retrospectively patients’ records were reviewed who underwent TDC placement during February 2016 to November 2020 at Department of Interventional Radiology, Liaquat National Hospital, Karachi, Pakistan. Patients’ age, gender, residence, comorbidity, catheter placement site, use of antibiotics before catheter insertion, reasons for catheter removal and total catheter days were retrieved from patients’ medical record file.RESULTS: 130 patients received TDC with a median follow-up of 148 (inter-quartile range: 60.8 – 274.3) days. 94(72.3%) catheters were electively removed whereas 18(13.8%), 16(12.3%) and 2(1.5%) catheters were removed due to infections, blockage and physical damage respectively. None of the mortality was observed due to catheter related complication. The incidence of overall infection, bacteremia and other infections during one year was 7.3, 5.01 and 3.19 per 10,000 patient-days respectively. Infection free survival rate was 68% with mean time to infection was 676.63 (95% CI: 593.87 – 759.39) days. During the study, total catheter patency was 53.2%. None of the patients’ characteristics was associated with catheter related infections and catheter patency.CONCLUSION: TDCs are the best available alternative for short to intermediate term use for hemodialysis when all preventive measures are taken to avoid catheter related complications either infectious or non-infectious until permanent dialysis access is achieved or renal transplant is done. It may also serve as long term hemodialysis mode in patients in whom permanent access or transplant is not preferred.

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma

Purpose: Catheter-related complications are observed in infusion of chemotherapy, and these were encountered with targeted therapies. Our principle is to study non-mechanical effects of type and initiation time of chemotherapy among the other factors on patency of totally implantable vascular access devices (TIVAD) inserted in patients with colorectal carcinoma. Methods: This is a one-center retrospective cohort study. We analyzed TIVAD related complications in 624 patients with colorectal carcinoma. The patients were categorized by chemotherapy type (non-target-directed chemotherapy agents (Group A), bevacizumab (Group B), and cetuximab (Group C)). Additionally, we divided the patients into groups by the time interval between TIVAD insertion and chemotherapy initiation. According to our study, a 3-day period was optimal. Therefore, we named the groups as within 3 days and beyond 3 days, and called this process 3 days cut-off. Age, gender, jugular-subclavian access, platelet count, INR, the types of chemotherapy, and the initiation time of chemotherapy were investigated by survival tests. We compared chemotherapy type groups both one-by-one and combined into one group. Results: The TIVADs were removed due to the complications in 11 patients of Group A, 6 patients of Group B, and 3 patients of Group C. Only chemotherapy type was significant ( p = 0.011) in Cox regression test. A clear difference ( p = 0.010) was detected between the catheter patency of Group A and combination of Groups B and C, because of skin necrosis and thrombosis. Within 3 days of their first chemotherapy day, an important difference between Group A and Group C ( p = 0.013) was observed in the TIVAD patency. The same observation was made between Group A and Group B ( p = 0.007). Beyond this period, no major difference was detected ( p = 0.341). Conclusion: A major effect on catheter patency was detected by using the target-directed chemotherapy agent within 3 days, which should be considered in target-directed chemotherapy.

Comparing the Effects of Pulsatile and Continuous Flushing on Time and Type of Peripheral Intravenous Catheters Patency: A Randomized Clinical Trial

Introduction: Peripheral intravenous catheters (PICs) patency techniques such as flushing are being developed. According to some studies, flushing can be used continuously or in pulsatile forms. This study aimed to compare the effects of pulsatile flushing (PF) and continuous flushing (CF) on time and type of PICs patency. Methods: In this double-blind randomized clinical trial, 71 patients were randomly assigned into two groups of PF (n=35) and CF (n=36). The PF protocol was performed as successive injections of 1 mL normal saline (N/S) per second (sec) with a delay of less than 1 sec until the completion of 5 mL of solution. However, CF protocol was performed by injecting 5 mL N/S within 5 sec without any delay before and after each medicine administration. Data related to the time and type of PICs patency were collected using a patency checklist every 12 hours (h) up to 96 h. The statistical analysis was done by R statistical software (Version 3.5.1). Results: The results showed that the number of PICs remaining open was not significantly different between PF and CF groups during 96 h. The highest number of PICs excluded from the study was related to the time of 96 h as a result of partial patency in the two groups. Conclusion: There was no difference between CF and PF regarding the time and type of PICs patency. Thus, both techniques can be used to maintain the catheter patency.

Hemodialysis catheter heparin lock related bleeding: Hemorrhagic shock every other day

Catheter dysfunction is an important cause of catheter loss. In order to prevent this, locking solutions with minimal risk of systemic anticoagulation are used to ensure catheter patency. At present the most commonly used solutions are either heparin or sodium citrate. According to the literature use of sodium citrate may be advantageous in reducing bleeding events. We report a case of hemorrhagic shock following hemodialysis catheter lock with heparin, reversed after switching solution to sodium citrate.

Effects of Pair Housing on Patency of Jugular Catheters in Rats (Rattus norvegicus)

Chronic vascular access devices are widely used in a variety of species for repeated blood sampling or substance administration. Jugular catheters are commonly used for studying addiction-related behaviors in rats. Rats with catheters have historically been individually housed for the duration of the study to prevent cage mates from damaging the catheter. The 2 goals of this study were to determine 1) the effects of pair housing on catheter patency and 2) the effects of pair housing on catheter patency of rats in a study of opioid self-administration and cue-induced reinstatement of opioid-seeking behavior. The latter study also represented an opportunity for experimental refinement as it evaluated the temporary use of a barrier that allowed for pair-housed rats to be physically separated. Male Heterogeneous Stock (HS; n = 24) and Sprague–Dawley(SD; n = 121) rats were allocated to either single- or pair-housed condition. To assess the effect of social housing on catheter patency, rats (HS, n = 24; SD, n = 36) were monitored in their assigned housing condition for one month, with scheduled evaluation of catheter patency and structural damage. To examine the effect of social housing on catheter patency during a study of opioid self-administration and cue-induced reinstatement of opioid-seeking behavior, rats (SD, n = 85) were monitored in their assigned housing condition with similar routine patency evaluations. Catheter patency rates between single- and pairhoused rats were not statistically different in the first experiment, and pair-housed animals were successfully maintained on an infusion study in the second experiment. The use of a barrier between pair-housed rats after surgery allowed continued social contact with no observed adverse effects. These results suggest that, pair housing is a viable option for rats with chronicvascular implants, and may improve their wellbeing by allowing them to display species-typical social behaviors.

P1152USE OF URGENT START PERITONEAL DIALYSIS IN END STAGE RENAL DISEASE PATIENTS: A RETROSPECTIVE ANALYSIS IN A NORTH-INDIAN POPULATION

Background and Aims End-stage renal diseases (ESRD) that are referred late to dialysis usually need hemodialysis via central vein catheter (CVC). Urgent start peritoneal dialysis (PD) can be used in these patients to avoid need of CVC. Catheter patency and other complications related to urgent-start PD have not been thoroughly clarified. We evaluated the clinical outcomes of urgent-start PD in a North-Indian cohort. Method In this retrospective study, we enrolled ESRD patients who were started on urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2008 to December 31, 2017, and followed them up to 10 years. Catheter failure was primary outcome of study while as secondary outcomes included short-term and long-term complications related to urgent-start PD. Results In this study882 patients (60.3% male, mean age 47.28 ± 14.1years) were enrolled. There were few peri-operative complications with significant hemorrhage seen in 2 patients. Early peritonitis occurred in 8 (0.9%) patients. Within the first month of catheter insertion, abdominal wall complications (hernia, hydrothorax, hydrocele, and leakage) occurred in 24 (2.7%) patients while as functional catheter malfunction developed in 36 (4.1%) patients. On follow-up of the patients (median 35.7 months), 32 (3.6%) patients experienced catheter failure, and 141 (15.9%) had death-censoring technique failure. Catheter patency rate at the end of 1-month, 1 -year, 3-year, and 5-year, was 98.2, 94.9, 93.1,92.4%; and technique survival rate was 99.2, 96.9, 90.2, 82.8%, respectively. Every 5-year increase in age was associated with 17% decrease of risk for catheter failure (hazard ratio [HR]: 0.83, 95%confidence interval [CI]: 0.73–0.89). Risk factors for abdominal wall complications included male sex (HR: 1.45, 95% CI: 1.03–2.1), low hemoglobin levels (HR: 0.88, 95% CI: 0.79–0.98) and diabetic nephropathy (HR: 1.65, 95% CI:1.13–2.35). Conclusion Urgent-start PD is a safe option for ESRD who need urgent dialysis to avoid CVC insertion for HD. For a successful urgent start PD programs, a well-trained PD team, catheter insertion procedure by experienced personnel, and a well-designed PD prescription and a good follow-up care is needed.

Duration of peripheral intravenous catheter patency in children

Objective This study aimed to compare the impact of saline lock to running a slow continuous infusion to-keep-vein-open (TKVO) on the total time a peripheral intravenous (PIV) catheter remained patent. Method A retrospective chart review of all children admitted to the paediatric ward of a regional hospital in Saskatchewan December 1, 2013 through February 28, 2014. Characteristics of patients with PIV catheters were abstracted from the health records, including patient size, catheter size and site, and total time each PIV catheter spent (i) infusing therapeutic fluids or medications, (ii) running a TKVO infusion, or (iii) saline locked. The duration of catheter patency was compared with the proportion of time that TKVO infusions were run, as well as patient gender and age. Results During 375 admissions, there were 189 PIVs which met inclusion criteria. The proportion of nontherapeutic time a PIV catheter spent TKVO compared to saline locked did not affect the total time the PIV catheter was patent (P=0.33). Gender had no influence, but older age, a nonmodifiable factor, was associated with increased time a PIV catheter remained patent (P=0.028). Discussion Peripheral intravenous (PIV) catheter insertion can be a painful and traumatic procedure. On the paediatric ward of a regional hospital, TKVO infusions were not superior to saline lock for prolonging PIV catheter patency.