Farklı Vasküler Giriş Yollarında Tünelli Hemodiyaliz Kateterlerinin Değerlendirilmesi

Öz

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

Anahtar Kelimeler

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

Evaluation of Tunneled Hemodialysis Catheters in Different Vascular Accesses

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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