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Vascular access for continuous renal replacement therapy

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Critical Care Nephrology

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Abstract

The main advantage of slow continuous dialysis techniques is that they can be used in patients with poor cardiovascular hemodynamics. This chapter reviews the choice of access, the problems resulting from vascular access creation and finally, briefly, the techniques of access creation in hemodynamically unstable patients. Although most data on vascular access techniques and problems are from chronic dialysis populations, the principles applied here have been extrapolated to apply more specifically to the ICU population.

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References

  1. Bellomo R, Parkin G. Love J, Boyce N. A prospective. comparative study of continuous arteriovenous hemodiafiltration and continuous hemodiafiltration in critically ill patients. Am J Kidney Dis 1993; 21: 400–4.

    PubMed  CAS  Google Scholar 

  2. Tominaga GT, Ingegno M, Cerldi C, Waxman K. Vascular complications of continuous arteriovenous hemofiltration in trauma patients. 1 Trauma 1993; 35: 285–8.

    Article  PubMed  CAS  Google Scholar 

  3. Bambauer R, Mestres P. Pirrung KJ. Frequency, therapy, and prevention of infections associated with large bore catheters. ASAIO J 1992; 38: 96–101.

    PubMed  CAS  Google Scholar 

  4. Kelber J. Delmez JA, Windus DW. Factors affecting delivery of high-efficiency dialysis using temporary vascular access. Am J Kidney Dis 1993; 22: 24–9.

    PubMed  CAS  Google Scholar 

  5. Simoni G, Gurreri G, Freidman D. Five years’ experience with Hickman catheters as temporary access for hemodialysis. Nephrol Dial Transplant 1990; 5: 59–61.

    Article  PubMed  CAS  Google Scholar 

  6. Maki DG, Cobb L. Garman JK, Shapiro JM. Ringer M. Helgerson RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective, randomized multi-center trial. Am J Med 1988; 85: 307–14.

    Article  PubMed  CAS  Google Scholar 

  7. Flowers RH, Schwenzer KJ, Kopel RF, Fisch MJ, Tucker SI, Farr BM. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection: A randomized, controlled trial. JAMA 1989; 261: 878–83.

    Article  PubMed  Google Scholar 

  8. Moss AH, Vasilakis C, Holley JL, Foulks CJ, Pillai K. McDowell DE. Use of silicone dual-lumen catheter with a dacron cuff as a long-term vascular access for hemodialysis patients. Am J Kidney Dis 1990; 211–5.

    Google Scholar 

  9. Schwab SJ, Buller GL, McCann RL, Bollinger RR, Stickel DL. Prospective evaluation of a dacron cuffed hemodialysis catheter for prolonged use. Am J Kid Dis 1988; 9: 166–9.

    Google Scholar 

  10. Fan, PY. Schwab SJ. Vascular access: concepts for the 1990s. J Am Soc Nephrol 1992; 3: 1–11.

    PubMed  CAS  Google Scholar 

  11. McDowell DE, Moss AH, Vasilakis C. Bell R, Pillai L. Percutaneously placed dual-lumen silicone catheters for long-term hemodialysis. Ann Surg 1993; 59: 569–73.

    CAS  Google Scholar 

  12. McDowell ED, Pillai L, Goldstein RM. A simplified technique for percutaneous insertion of permanent vascular access catheters in patients requiring chronic hemodialysis. J Vase Surg 1988; 7: 574–6.

    CAS  Google Scholar 

  13. Uldall R, DeBruyne M. Besley M. McMillan J, Simons M, Francoeur R. A new vascular access catheter for hemodialysis. Am J Kidney Dis 1993; 21: 270–7.

    PubMed  CAS  Google Scholar 

  14. Uldall R. Percutaneous jugular vein cannulation for hemodialysis access in patients with end-stage renal failure: special points of technique. Semin Dial 1995; 8: 187–91.

    Article  Google Scholar 

  15. Tesio F. De Baz H. Panarello G, Calianno G. Quaia P, Raimondi A, Schinella D. Double catheterization of internal jugular vein for hemodialysis: indications, techniques and clinical results. Artif Organs 1994; 18: 301–4.

    Article  PubMed  CAS  Google Scholar 

  16. Tominaga GT, Ingegno MD, Scannell G, Pahl MV, Waxman K. Continuous arteriovenous hemodiafiltration in postoperative and traumatic renal failure. Am J Surg 1993; 166: 612–5.

    Article  PubMed  CAS  Google Scholar 

  17. Bellomo R, Parking G, Love J, Boyce N. Use of continuous hemodiafiltration: an approach to the management of acute renal failure in the critically ill. Am J Nephrol 1992; 12: 240–5.

    Article  PubMed  CAS  Google Scholar 

  18. Bosch FH, van Leusen R. Vascular access in continuous arteriovenous hemodialfiltration. Artif Organs 1994; 18: 298–300.

    Article  PubMed  CAS  Google Scholar 

  19. Alarabi A, Eklund T, Claesson K, Wikstrom B, Danielson BG. Experience with vascular access for acute renal failure: using Buselmeier shunt and femoral vessel catheter. Nephron 1991; 2: 192–5.

    Article  Google Scholar 

  20. Ahmed Z. Introduction of percutaneous arteriovenous femoral shunt: a new access for continuous arteriovenous hemofiltration. Am J Kidney Dis 1990; 16: 115–7.

    PubMed  CAS  Google Scholar 

  21. Bellomo R, Teede H, Boyce N. Anticoagulant regimens in acute continuous hemodiafiltration: a comparative study. Intensive Care Med 1993; 19: 329–32

    Article  PubMed  CAS  Google Scholar 

  22. Tapson JS, Uldall PR. Fatal hemothorax caused by a subclavian hemodialysis catheter. Arch Intern Med 1984; 44: 1865–87.

    Google Scholar 

  23. El-Shahawy MA, Khilnani H. Carotid-jugular arteriovenous fistula: a complication of temporary hemodialysis catheter. (review) Am J Nephrol 1995; 15: 332–6.

    Article  PubMed  CAS  Google Scholar 

  24. Barton BR, Hermann G, Weil R. Cardiothoracic emergencies associated with subclavian hemodialysis catheters. JAMA 1983; 250: 2660–2.

    Article  PubMed  CAS  Google Scholar 

  25. Fincher ME, Caruana RJ, Humphries A, Gross CM, Rubin JW, Bowen PA. Right atrial thrombus formation following central venous dialysis catheter placement. Am Surg 1988; 54: 652–4.

    PubMed  CAS  Google Scholar 

  26. Wright RS, Quinones-Baldrich WJ, Anders AJ, Danovitch GM. Pleural effusion associated with ipsilateral breast and arm edema as a complication of subclavian vein catheterization and arteriovenous fistula formation for hemodialysis. Chest 1994; 106: 950–2.

    Article  PubMed  CAS  Google Scholar 

  27. Walters GK, Jones CE. Lymphorrhea following percutaneous right supraclavicular hemodialysis catheter replacement. Nephron 1993; 64: 500.

    Article  PubMed  CAS  Google Scholar 

  28. Horowitz MD, Alkire MJ, Lickstein DA, Bauerlein EJ. Aortic injury as a complication of central venous catheterization. Am Heart J 1991; 122: 595–7.

    Article  PubMed  CAS  Google Scholar 

  29. Chou TM, Sweeney JP, Massie BM. Marked T-wave inversion after internal jugular cannulation complicated by neck hematoma. Am Heart J 1994; 128: 1038–40.

    Article  PubMed  CAS  Google Scholar 

  30. Korzets A, Katz S, Chagnac A, Katz M, Gafter U, Zevin D, Levi J. An infected right atrial thrombus: a new complication of hemodialysis associated subclavian vein catheterisation. Nephrol Dial Transplant 1994; 9: 1652–4.

    PubMed  CAS  Google Scholar 

  31. Kaupke CJ, Ahdout J, Vaziri ND, Deutsch LS. Perforation of the superior vena cava by a subclavian hemodialysis catheter: early detection by angiograph. Int J Artif Organs 1992; 15: 666–8.

    PubMed  CAS  Google Scholar 

  32. Shinozaki T, Deane RS, Mazuzan JE Jr, Hamel AJ, Hazelton D. Bacterial contamination of arterial lines. JAMA 1983; 249: 223–5.

    Article  PubMed  CAS  Google Scholar 

  33. Hung KY, Tsai TJ, Yen CJ, Yen TS. Infection associated with double lumen catheterization for temporary hemodialysis: exerience of 168 cases. Nephrol Dial Transplant 1995; 10: 247–51.

    PubMed  CAS  Google Scholar 

  34. Raaf JH. Result from use of 826 vascular access devices in cancer patients. Cancer 1985; 55: 1312–21.

    Article  PubMed  CAS  Google Scholar 

  35. Twardowski ZJ. Percutaneous blood access for hemodialysis. Semin Dial 1995: 8: 175–86.

    Article  Google Scholar 

  36. Capdevila JA, Segarra A, Planes AM, Ramirez-Arellano M, Pahissa A, Piera L, Martinez-Vazquez JM. Successful treatment of hemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant 1993; 8: 231–4.

    PubMed  CAS  Google Scholar 

  37. Cobb DK, High KP, Sawyer RG, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992; 327: 1062–8.

    Article  PubMed  CAS  Google Scholar 

  38. Swartz R. The PermCath: long-term vascular access for hemodialysis. Proceedings of the Second International Symposium on Daily Home Hemodialysis. 1996.

    Google Scholar 

  39. Carlisle EJF, Blake P, McCarthy F, Vas S, Uldall PR. Septicemia in long-term jugular hemodialysis catheters: eradicating infection by changing the catheter over a guidewire. Int J Artif Organs 1991; 14: 150–3.

    PubMed  CAS  Google Scholar 

  40. Sitzman JV, Townsend TR, Siler MC, Barlett JG. Septic and technical complications of central venous catheterization. A prospective study of 200 consecutive patients. Ann Surg 1985; 202: 766–70.

    Article  Google Scholar 

  41. Lewis JA, LaFrance R, Bower RH. Treatment of an infected silicone right atrial catheter with combined fibrinolytic and antibiotic therapy: case report and review of the literature. JPEN 1989; 13: 92–8.

    Article  CAS  Google Scholar 

  42. Jones GR, Konsler GK, Dunaway RP, Lacey SR, Azizkhan RG. Prospective analysis of urokinase in the treatment of catheter sepsis in pediatric hematology-oncology patients. J Ped Surg 1993; 28: 350–7.

    Article  CAS  Google Scholar 

  43. Glynn MFX, Langer B, Jeejeebhoy KN. Therapy for thrombotic occlusion of long-term intravenous alimentation catheters. JPEN 1980; 4: 387–90.

    Article  CAS  Google Scholar 

  44. Haffar AAM, Rench MA, Ferry GD, Seavy DE, Edwards MS. Failure of urokinase to resolve Broviac catheter-related bacteremia in children. J Pediatr 1984; 104: 256–8.

    Article  PubMed  CAS  Google Scholar 

  45. Curnow A, Idowu J, Behrens E, Toomey F, Georgeson K. Urokinase therapy for silastic catheter-induced intravascular thrombi in infants and children. Arch Surg 1985; 120: 1237–40.

    Article  PubMed  CAS  Google Scholar 

  46. Agraharkar M, Isaacson S, Mendelssohn D, Muralidharan J, Mustata S, Zevallos G, Besley M, Uldall R. Percutaneously inserted silastic jugular hemodialysis catheters seldom cause jugular vein thrombosis. ASAIO Journal 1995; 42: 169–72.

    Google Scholar 

  47. Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in hemodialysis: comparative angiographie study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6: 722–4.

    Article  PubMed  CAS  Google Scholar 

  48. El Nachef MW, Rashad E, Ricanati ES. Occlusion of the sublcavian vein: a complication of indwelling subclavian venous catheters for hemodialysis. Clin Nephrol 1985; 24: 42–6.

    PubMed  Google Scholar 

  49. Brady HR, Fitzcharles B, Goldberg H, Huraib S. Simons M, Uldall PR. Diagnosis and management of subclavian vein thrombosis occurring in association with subclavian cannulation for hemodialysis. Blood Purif 1987; 7: 210–7.

    Article  Google Scholar 

  50. Glaze RC, McDougall ML, Wcigmann TB. Thrombotic arm edema as a complication of subclavian vein cathetcrisation and arteriovcnous fistula formation for hemodialysk. Am J Kidney Dis 1986: 7: 439–41.

    PubMed  CAS  Google Scholar 

  51. Clark DD. Albina JE. Chezan JA. Subclavian vein stenosis and thrombosis: a potential serious complication in chronic hemodialysis patients. Am J Kidney Dis 1990; 15: 256–68.

    Google Scholar 

  52. Spinowitz BS. Galler M. Golden RA, et al. Subclavian vein stenosis as a complication of subclavian catheterisation for hemodialysis. Arch Int Med 1987; 147: 3057.

    Article  Google Scholar 

  53. Vanherweger JL, Yassine T, Goldman M, et al. Subclavian vein thrombosis: a frequent complication of subclavian vein cannulation for hemodialysis. Clin Nephrol 1986; 26: 235–8.

    Google Scholar 

  54. Barrett N. Spencer S, Mclvor J, Brown EA. Subclavian stenosis: a major complication of subclavian dialysis catheters. Nephrol Dial Transplant 1988: 3: 423–5.

    PubMed  CAS  Google Scholar 

  55. Udall PR, Besley ME, Thomas A, Salter S, Nuezca LA, Vas M. Maintaining the patency of double-lumen silastic jugular catheters for hemodialysis. Int J Artif Organs 1993; 16: 37–40.

    Google Scholar 

  56. Shrivastava D, Lundin AP, Dosunmu B, Rao TK, Beyer MM, Friedman EA. Salvage of clotted jugular vein hemodialysis catheters. Nephron 1994; 68: 77–9.

    Article  PubMed  CAS  Google Scholar 

  57. Twardowski ZJ, Van Stone JC, Jones ME, Klusmeyer ME, Haynie JD. Blood recirculation in intravenous catheters for hemodialysis. J Am Soc Nephrol 1993; 3: 1978–81.

    PubMed  CAS  Google Scholar 

  58. Levin A, Mason AJ, Jindal KK, Fong IW. Goldstein MB. Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine. Kidney Int 1991: 40: 934–8.

    Article  PubMed  CAS  Google Scholar 

  59. Sheth KJ Hendrickson KJ. Prevention of recurrent central venous catheter infections with a novel flush solution in a patient on long-term hemodialysis. (letter) Pediatr Nephrol 1993; 7: 506.

    Article  PubMed  CAS  Google Scholar 

  60. Hendrickson KJ. Dunne WM Jr. Modification of central catheter Hush solution improves in vitro antimicrobial activity. J Infect Dis 1992; 166: 944–6.

    Article  Google Scholar 

  61. Vazquez RN, Jarrard MM. Care of central venous catheterisation site. The use of transparent polyurethane film. J Parenteral & Enteral Nutrition 1980; 8: I81–6.

    Google Scholar 

  62. Holland KT, Hamby D, Peel B. A comparison of the in vivo antibacterial effects of ‘opsite’. ‘tegaderm’ and ‘ensure’ dressings. J Hasp Infect 1985; 6: 299–303.

    CAS  Google Scholar 

  63. Conty DG, Grieves K. Peters B. A prospective, randomized study comparing transparent and dry gauze des-sings for central venous catheters. J Infect Dis 1989: 159: 310–9.

    Article  Google Scholar 

  64. Zinner SH. Denny-Brown BC, Braun P, et al. Risk of infection with intravenous indwelling catheters: effect of application of antibiotic ointment. J Infect Dis 1969; 120: 616–9.

    Article  PubMed  CAS  Google Scholar 

  65. Norden CW. Application of antibiotic ointment to the site of venous catheterization: a controlled trial. J Infect Dis 1969; 120: 611–5.

    Article  PubMed  CAS  Google Scholar 

  66. Levy RS, Goldstein J, Pressman RS. Value of a topical antibiotic ointment in reducing bacterial colonization of percutaneous venous catheters. J Albert Einstein Med Center 1970: 18: 67–70.

    Google Scholar 

  67. Maki DB, Band JD. A comparative study of poly-antibiotic and iodophor ointments in prevention of vascular catheter-related infection. Am J Med 1981; 70: 739–44.

    Article  PubMed  CAS  Google Scholar 

  68. Maki DG, Ringer M, Alvarado CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991; 338: 339–43.

    Article  PubMed  CAS  Google Scholar 

  69. McDowell DE, Pillai L, Goldstein RM. A simplified technique for percutaneous insertion of permanent vascular access catheters in patients requiring chronic hemodialysis. J Vase Surg 1988: 7: 574–6.

    CAS  Google Scholar 

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Authors
  1. Vanita Jassal
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  2. Andreas Pierratos
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© 1998 Springer Science+Business Media Dordrecht

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Jassal, V., Pierratos, A. (1998). Vascular access for continuous renal replacement therapy. In: Critical Care Nephrology. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5482-6_100

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  • DOI: https://doi.org/10.1007/978-94-011-5482-6_100

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6306-7

  • Online ISBN: 978-94-011-5482-6

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