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      Unusual Complication of Central Venous Catheter in Hemodialysis

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          Abstract

          A case of a partial rupture of a cuffed central venous catheter (CVC) implanted in the femoral vein with the purpose of being used for chronic hemodialysis is described in a 74-year-old female patient. Of relevance is that the CVC described was from the same manufacturer as the previous one that had lasted 12 years.

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          Most cited references 17

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          Type of vascular access and mortality in U.S. hemodialysis patients.

          Vascular access (VA) complications account for 16 to 25% of hospital admissions. This study tested the hypothesis that the type of VA in use is correlated with overall mortality and cause-specific mortality. Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Study Wave 1, a random sample of 5507 patients, prevalent on hemodialysis as of December 31, 1993. The relative mortality risk during a two-year observation was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Using similar methods, cause-specific analyses also were performed for death caused by infection and cardiac causes. In diabetic mellitus (DM) patients with end-stage renal disease, the associated relative mortality risk was higher for those with arteriovenous graft (AVG; RR = 1.41, P < 0.003) and central venous catheter (CVC; RR = 1.54, P < 0.002) as compared with arteriovenous fistula (AVF). In non-DM patients, those with CVC had a higher associated mortality (RR = 1.70, P < 0.001), as did to a lesser degree those with AVG (RR = 1.08, P = 0.35) when compared with AVF. Cause-specific analyses found higher infection-related deaths for CVC (RR = 2.30, P < 0.06) and AVG (RR = 2.47, P < 0.02) compared with AVF in DM; in non-DM, risk was higher also for CVC (RR = 1.83, P < 0.04) and AVG (RR = 1.27, P < 0.33). In contrast to our hypothesis that AV shunting increases cardiac risk, deaths caused by cardiac causes were higher in CVC than AVF for both DM (RR = 1.47, P < 0.05) and non-DM (RR = 1.34, P < 0.05) patients. This case-mix adjusted analysis suggests that CVC and AVG are correlated with increased mortality risk when compared with AVF, both overall and by major causes of death.
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            Vascular access and increased risk of death among hemodialysis patients.

            Hemodialysis with a venous catheter increases the risk of infection. The extent to which venous catheters are associated with an increased risk of death among hemodialysis patients has not been extensively studied. We conducted a retrospective cohort study of 7497 prevalent hemodialysis patients to assess the association between dialysis with a venous catheter and risk of death due to all causes and to infection. A tunneled cuffed catheter was used for access in 12% of the patients and non-cuffed, not tunneled catheter in 2%. Younger age (P = 0.0005), black race (P = 0.0022), female gender (P = 0.0004), short duration since starting dialysis (P = 0.0003) and impaired functional status (P = 0.0001) were independently associated with increased use of catheter access. The proportion of patients who died was higher among those who were dialyzed with a non-cuffed (16.8%) or cuffed (15.2%) catheter compared to those dialyzed with either a graft (9.1%) or a fistula (7.3%; P < 0.001). The proportion of deaths due to infection was higher among patients dialyzed with a catheter (3.4%) compared to those dialyzed with either a graft (1.2%) or a fistula (0.8%; P < 0.001). The adjusted odds ratio (95% CI) for all-cause and infection-related death among patients dialyzed with a catheter was 1.4 (1.1, 1.9) and 3.0 (1.4, 6.6), respectively, compared to those with an arteriovenous (AV) fistula. Venous catheters are associated with an increased risk of all-cause and infection-related mortality among hemodialysis patients.
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              Ultrasound and Arterial Wall Disease

              Rapid progress in non-invasive ultrasound techniques has resulted in a wide variety of clinical applications for the assessment of cerebrovascular diseases. Recent highlights in ultrasound research include the evaluation of vascular ageing as a degenerative process, the demonstration of plaque development, motion and vulnerability in atherosclerosis and multi-dimensional as well as innovative imaging techniques (e.g., compound imaging) to depict early and small vascular lesions. In addition, echo-contrast agents have been used to compensate for difficulties in visualising late, severe or subtotal obstructive plaques, but failed to be really superior to conventional techniques as evidenced in a prospective, multi-centre trial (Contrast Enhanced Duplex sonography versus Arteriography Studies – CEDAS). With increasing sophistication of ultrasound methodology, it becomes essential to establish standards for data acquisition and interpretation: three consensus meetings have provided detailed recommendations on quantification of carotid atherosclerosis, characterisation of carotid artery plaques and detection of microembolism by transcranial Doppler as a potential indicator of stroke risk.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2005
                December 2005
                19 December 2005
                : 23
                : 6
                : 446-449
                Affiliations
                aUO di Nefrologia e Dialisi e bUO di Radiologia, PO ‘A Landolfi’, Solofra, Italia
                Article
                88216 Blood Purif 2005;23:446–449
                10.1159/000088216
                16155377
                © 2005 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, References: 31, Pages: 4
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/88216
                Categories
                Case Report

                Cardiovascular Medicine, Nephrology

                Hemodialysis, Central venous catheter

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