Özgür ÇAKIR, Ural KOÇ, Metin ERGÜL, İsa ÇAM, Ahmet YALNIZ, Ercüment ÇİFTÇİ, Samet GENEZ, Erkan ŞENGÜL, Servan YAŞAR, Ceylan Altıntaş TAŞLIÇAY

FARKLI VASKÜLER GİRİŞ YOLLARINDA TÜNELLİ HEMODİYALİZ KATETERLERİNİN DEĞERLENDİRİLMESİ

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

EVALUATION OF TUNNELED HEMODIALYSIS CATHETERS IN DIFFERENT VASCULAR ACCESSES

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. Catheterpatency 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(721 and 1276 days, respectively) was higher in the right IJV group compared with the others (p

PDF

___

1. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(suppl1):248-273.
2. 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.
3. III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001;37: 137-181.
4. 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.
5. Rakesh N, Sidney R. The KDOQI 2006 vascular access update and fistula first program synopsis. Semin Intervent Radiol. 2009;26(2):122-124.
6. 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.
7. Maya ID, Allon M. Outcomes of tunneled femoral hemodialysis catheters: Comparison with internal jugular vein catheters. Kidney Int. 2005;68(6):2886-2889.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. London: NICE, 2002.
19. 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.
20. Fry AC, Stratton J, Farrington K, et al. Factors affecting longterm survival of tunnelled haemodialysis catheters-a prospective audit of 812 tunnelled catheters. Nephrol Dial Transplant. 2008;23(1):275-81.