Farklı Vasküler Giriş Yollarında Tünelli Hemodiyaliz Kateterlerinin Değerlendirilmesi

Year 2021, , 168 - 173, 29.05.2021

İsa Çam , Samet Genez , Erkan Şengül , Ural Koç , Ahmet Yalnız , Özgür Çakır , Metin Ergül , Servan Yaşar , Ceylan Altıntaş Taşlıçay Ercüment Çitfçi

https://doi.org/10.30934/kusbed.884274

Abstract

Amaç: Tünelli hemodiyaliz kateterleri için farklı vasküler erişim yollarında açıklık oranlarını ve tıkanma nedenlerini belirlemektir.
Yöntem: 14 french tünelli hemodiyaliz kateteri takılan 106 hastanın kayıtları retrospektif olarak analiz edildi (40 sağ internal jugular ven (İJV), 23 sol İJV, 18 sağ femoral ven (FV), 11 sol FV ve 14 transhepatik ven). Kateter açıklık sağkalımı Kaplan-Meier eğrisi kullanılarak gösterildi. Kateter tıkanma ve değişim nedenleri değerlendirildi.
Bulgular: Tüm hastalarda toplam 474 kateter değişimi yapıldı (ortalama değişim sayısı: 4,47±1,62). Kateter tıkanma ve değişim nedenleri, kateterle ilişkili enfeksiyon, kateter trombozu, fibrin kılıfı ve kateter malpozisyonu idi. Sağ İJV grubunda ortalama primer ve kümülatif kateter açıklık süresi diğerlerine göre daha yüksekti (p<0,001). Sağ İJV grubunda ortalama kateter birincil ve kümülatif açıklık süresi sırasıyla 737 ve 1337 gündü. Kateterle ilişkili enfeksiyonların insidansı sol FV'de (100 hasta günü için 0,42) daha yüksek, kateter malpozisyonu ise transhepatik (100 hasta günü için 0,38) ve sol İJV grubunda (100 hasta günü için 0,32) daha yüksekti.
Sonuç: Tünelli hemodiyaliz kateteri için ilk erişim yolu sağ İJV olmalıdır. Çalışmamızın sonuçlarına göre sağ İJV kullanılabilir değilse; sırasıyla sol İJV, sağ FV, sol FV ve transhepatik erişim yolları kullanılmalıdır

Keywords

Hemodiyaliz, Tünelli kateter, Vasküler erişim, Kateter disfonksiyonu, Kateter sağkalım oranı, Fibrin kılıf

Evaluation of Tunneled Hemodialysis Catheters in Different Vascular Accesses

Abstract

Objective: To determine the patency rates and reasons for failure using different access routes for tunneled hemodialysis catheters.
Methods: The records of patients who underwent insertion of 14 French tunnelled hemodialysis catheters were retrospectively analyzed. Catheter patency survival was demonstrated using Kaplan-Meier survival curve. Catheter failure and exchange reasons were evaluated.
Results: One hundred and six patients underwent 474 catheter exchanges (mean/patient 4.47±1.62). Access was via right internal jugular vein (IJV) n=40, left IJV n=23, right femoral vein (FV) n=18, left FV n=11 and transhepatic vein n=14. The causes of catheter failure and exchange were: catheter-associated infection, catheter thrombosis, fibrin sheath and catheter tip malposition. Mean primary and cumulative catheter patency time was higher in the right IJV group (732 and 1337 days, respectively) compared with the others (p<0.001). The incidence of catheter-related infections was higher in the left FV (0.42/100 patient-days) and catheter tip malposition was higher in the transhepatic (0.38/100 patient-days) and in the left IJV (0.32/100 patient-days).
Conclusion: The use of right IJV should be the first option for hemodialysis access route. Based on our findings, if right IJV is unavailable the optimal access routes in order would be left IJV, right FV, left FV and finally transhepatic vein.

Keywords

Hemodialysis, Tunneled catheter, Vascular access, Catheter dysfunction, Catheter survival rate, Fibrin sheath

References

• Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(suppl1):248-273. Doi: 10.1053/j.ajkd.2006.04.029.
• Saran R, Li Y, Robinson B, et al: US Renal Data System 2015 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis. 2016;67: 1-305. Doi: 10.1053/j.ajkd.2015.12.014
• NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001;37: 137-181 Doi: 10.1016/s0272-6386(01)70007-8
• Kukita K, Ohira S, Amano I, et al. 2011 update Japanese Society for Dialysis Therapy guidelines of vascular access construction and repair for chronic hemodialysis. Ther Apher Dial. 2015;19:1-39. Doi:10.1111/1744*9987.12296
• Rakesh N, Sidney R. The KDOQI 2006 vascular access update and fistula first program synopsis. Semin Intervent Radiol. 2009;26(2):122-124. Doi: 10.1055/s-0029-1222455
• Polkinghorne KR, Chin GK, MacGinley RJ, et al. KHA-CARI Guideline: Vascular Access- central venous catheters, arteriovenous fistulae and arteriovenous grafts. Nephrology (Carlton). 2013;18(11):701-705. Doi: 10.1111/nep.12132
• Maya ID, Allon M. Outcomes of tunneled femoral hemodialysis catheters: Comparison with internal jugular vein catheters. Kidney Int. 2005;68(6):2886-2889. Doi: 10.1111/j.1523-1755.2005.00762.x
• Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: Comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant. 1991;6(10):722-724. Doi: 10.1093/ndt/6.10.722,
• Guillermo-Corpus G, Ramos-Gordillo JM, Peña-Rodríguez JC. Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients. Blood Purif. 2019;47(1-3):132-139. Doi: 10.1159/000494206
• Pereira K, Osiason A, Salsamendi J. Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm. J Clin Imaging Sci. 2015; 29:31.Doi: 10.4103/2156-7514.157858
• Ervo S, Cavatorta F, Zollo A. Implantation of permanent jugular catheters in patients on regular dialysis treatment: ten years’ experience. J Vasc Access. 2001;2(2):68-72. Doi: 10.1177/112972980100200209
• Ewing F, Patel D, Petherick A, Winney R, McBride K. Radiological placement of the AshSplit hemodialysis catheter: a prospective analysis of outcome and complications. Nephrol Dial Transplant. 2002;17(4):614-619. Doi: 10.1093/ndt/17.4.614
• Weber E, Liberek T, Wołyniec W, Gruszecki M, Rutkowski B. Survival of tunneled hemodialysis catheters after percutaneous placement. Acta Biochim Pol. 2016;63(1):139-143. Doi: 10.18388/abp.2015_1111
• Coker MA, Black JR, Li Y, et al. An analysis of potential predictors of tunneled hemodialysis catheter infection or dysfunction. J Vasc Access. 2019;20(4):380-385. Doi: 10.1177/1129729818809669
• Şanal B, Nas ÖF, Doğan N, et al. Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients. Diagn Interv Radiol. 2016;22(6):560-565. Doi: 10.5152/dir.2016.16043
• Valliant AM, Chaudhry MK, Yevzlin AS, Astor B, Chan MR. Tunneled dialysis catheter exchange with fibrin sheath disruption is not associated with increased rate of bacteremia. J Vasc Access. 2015;16(1):52-56. Doi: 10.5301/jva.5000301
• Shanaah A, Brier M, Dwyer A. Fibrin sheath and its relation to subsequent events after tunneled dialysis catheter exchange. Semin Dial. 2013;26(6):733-737. Doi: 10.1111/sdi.12074
• National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. London: NICE, 2002.
• Shi M, Cui T, Ma L, Zhou L, Fu P. Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center. Blood Purif. 2017;43(4):321-326. Doi: 10.1159/000455062
• Fry AC, Stratton J, Farrington K, et al. Factors affecting long-term survival of tunnelled haemodialysis catheters-a prospective audit of 812 tunnelled catheters. Nephrol Dial Transplant. 2008;23(1):275-81. Doi: 10.1093/ndt/gfm582