Dialysis, either hemodialysis or peritoneal dialysis, is a life-savingprocedure that replaces kidney function when the organs fail. In order tobe treated with dialysis, physicians must establish a connection betweenthe dialysis equipment and the patient's bloodstream. Dialysis accesssurgery creates the vascular opening so a needle can be inserted forhemodialysis or an abdominal catheter inserted for peritoneal dialysis.
Catheters come in two varieties, temporary and permanent. Temporarycatheters penetrate the skin and directly enter the venous system.Permanent catheters also penetrate the skin, but are then tunneled underthe skin for several inches before they finally enter the venous system.Tunneling the catheter reduces the risk of infection.
Any medical professional can place a temporary catheter using a localanesthetic and minimal sedation to help with minor discomfort. However forplacement of permanent catheters, a surgeon in the operating room, or aninterventional radiologist in the interventional suite is necessary. Duringthe procedure, physicians use fluoroscopy (continuous X-rays) to be surethe catheter is positioned correctly. Permanent catheters require a minorprocedure for removal whereas temporary catheters can simply be pulled out.
Another possible complication from long-term catheter use is damage to themain chest vessels, which can lead to stenosis (narrowing) or thrombosis(clotting) of the veins. This type of damage is usually permanent and thevessel - as well as the arm on the side of the vessel - may no longer beuseable for dialysis access.
The best approach is to undergo dialysis access surgery well beforedialysis therapy needs to begin, which will give the access site time tomature and avoid the use of temporary catheters. You may need a temporarycatheter while you are waiting for your permanent AV fistula or AV graft toheal.
Creating permanent vascular access (VA) is recommended before hemodialysis initiation in patients with end-stage renal disease (ESRD). Although many patients are still introduced to hemodialysis with temporary central venous catheters (CVCs), the reasons for their use remain unclear. We aimed to clarify the characteristics of Japanese patients introduced to hemodialysis using temporary CVCs, the reasons for their use, and whether this rate can be reduced in the future.
Patients with ESRD should be referred to a nephrologist earlier for AVF creation. However, given the already relatively high rate of hemodialysis initiation with permanent VA in Japan, we considered it surprisingly difficult to further reduce the temporary CVC usage rate in Japan.
Although decreasing the rate of using a temporary CVC at HD introduction would both improve patient prognosis and control healthcare costs by reducing hospitalization time and VA failure, few reports have identified the characteristics and reasons associated with initiating HD with a temporary CVC . We believe that it is possible to identify strategies for reducing the rate of HD initiation with a temporary CVC by determining the reasons for using a temporary CVC at HD initiation. Therefore, this study aimed to clarify the characteristics of patients who were initiated on HD with a temporary CVC and to determine why temporary CVCs were used for reducing the rate of HD initiation with temporary CVCs in the future. We also surveyed the types of permanent VA created and the time from the creation to the first cannulation of permanent VA.
We reviewed medical records to identify why the patients in the temporary CVC group were unable to establish permanent VA at HD initiation. The reason was determined by the concurrence of two nephrologists. We also surveyed the types of first permanent VA created in the CVC group and the time from HD initiation to the creation and first cannulation of permanent VA.
Of the 393 patients included in this study, HD was initiated using a temporary CVC in 137 (35%). An AVF was created in all patients in the temporary CVC group during hospitalization following HD initiation, and most patients were transferred to a maintenance dialysis facility after their AVF became usable. All of the remaining 256 patients (65%) initiated HD via AVF cannulation. None of the patients in either group had an AVG or tunneled CVC established as their first permanent VA (Fig. 1).
In the present study, AVFs were punctured earlier in the temporary CVC group compared with previous studies. The late referral to a nephrologist and the short duration of predialysis nephrology care were reported to increase the rate of HD initiation with a temporary CVC and lead to early AVF cannulation [16, 17]. Although this study did not investigate patient prognosis, a late referral and HD initiation with a temporary CVC have been reported to be associated with poor prognosis [18, 19], and early AVF puncture has been shown to increase AVF failure [9, 16]. Thus, particular attention should be paid to AVF failure in patients with a temporary CVC.
This study revealed the characteristics and reasons why patients were initiated on HD with a temporary CVC. ESRD patients should be referred to a nephrologist earlier for AVF creation. However, we found that the reasons for using a temporary CVC at HD initiation were varied and complex. Given the already relatively high rate of HD initiation with permanent VA in Japan, it may be surprisingly difficult to further reduce the rate of temporary CVC use at HD initiation by changing the behavior of healthcare providers and CKD patients. Future international prospective studies are necessary to reveal more details of the reasons for using a temporary CVC at HD initiation worldwide, and we hope the rate of temporary CVC use is gradually reduced as much as possible in the future.
All central lines (permanent, temporary, implanted ports, and umbilical lines) will be treated the same for making device attribution determinations (specifically, CLABSI) and for counting denominator device days (central line days).
Only 1 central line day is counted per patient-per calendar day regardless of how many lines the patient may have in place at the same time. If a patient in a SCA/Oncology unit has both a temporary and a permanent line, only report the temporary line because it has a higher risk of infection.
Bruno C Silva, Camila E Rodrigues, Regina CRM Abdulkader, Rosilene M Elias Nephrology Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis. Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008) and B (from 2013 to 2015). Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P
Dialysis is performed so regularly for some patients, that it makes sense to create a permanent access point for dialysis. This often comes in the form of a fistula, or the joining of an artery and a vein in the arm, that provides a steady flow of blood that can be filtered and processed by the artificial kidney. Arteriovenous fistulas are considered the gold standard for patients who require dialysis on a regular basis.
Catheters are usually used for short-term access, but can sometimes be permanent. A catheter is inserted into a large vein or artery in the neck or chest for access to the blood. Catheters are considered a poor permanent option for dialysis because they sit both sides and outside the body and are prone to infection. The catheter must also always be kept dry, so swimming or bathing are not allowed. They are also unsightly and unwieldy when getting dressed and undressed. Of the three options, catheters allow for the slowest flow of blood.
The AV fistula is preferred over grafts or catheters by most doctors for a number of reasons. It tends to offer the greatest amount of blood flow, so patients are in dialysis and uncomfortable for the shortest amount of time. Because they are a natural part of the body, they last much longer and are less expensive to maintain than a graft or catheter. They also offer a much lower risk of infection or clotting, which means fewer complications for patients who are already dealing with regular dialysis.
This family of dual lumen catheters is indicated for hemodialysis, apheresis and infusion. The catheters are available in straight extension and curved extension catheter options in kit configurations.
This family of dual lumen catheters is indicated for hemodialysis, apheresis and infusion. The catheters are available in straight extension and curved extension catheter options in single and kit configurations.
This family of dual lumen catheters is indicated for hemodialysis, apheresis and infusion. These catheters are available in straight extension, curved extension and pre-curved catheter options and singles, kit, tray (IC Tray) and safety tray (PASS Tray) configurations.
This family of triple lumen catheters is indicated for hemodialysis, apheresis, infusion, central venous pressure monitoring and high pressure contrast injection. These catheters are available in straight extension and curved extension catheter options and kit, tray (IC Tray) and safety tray (PASS Tray) configurations. 2b1af7f3a8