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      Complications Associated with Permanent Internal Jugular Hemodialysis Catheter: A Retrospective Study

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          Abstract

          Introduction

          A significant increase in patients with end-stage renal disease has been observed currently in our community. Kidney transplantation is the most promising cure but the problem is that large numbers of people are not good candidates for transplantation. Hemodialysis is the next appropriate medication for such patients and for patients with end-stage renal disease, who have no chance for transplantation. Morbidity and mortality are the consequences of vascular access complications. Local data related to the complication rate of permanent hemodialysis catheters is not available. The current study examines the complication rate in people due to permanent intrajugular hemodialysis catheterization.

          Materials and methods

          The study has been conducted in Dr Ziauddin University Hospital, Karachi. The dataset consists of 212 patients who had gone through jugular catheterizations for hemodialysis at this hospital from the year 2014 to the year 2015. A descriptive method has been chosen for obtaining appropriate results. Complications have also been categorized as early or late.

          Results

          Complications have been detected in around 24% of the patients from the dataset. Among these complications, infection has the highest percentage (around 13%) while 4% percent of patients have a failed puncture. The others have venous thrombosis, catheter thrombosis, hematoma, wrong canulation, and hemothorax and pneumothorax problems.

          Conclusion

          The study concludes that the placement of a permanent hemodialysis catheter in the internal jugular vein has a low complication rate. In addition, the method is safe and easy. So, it can be said that the internal jugular vein is a reliable and preferred route for hemodialysis catheterization.

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          Most cited references18

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          The USRDS: what you need to know about what it can and can't tell us about ESRD.

          This article summarizes the administrative structure underlying the Unites States Renal Data System (USRDS); summarizes incidence, prevalence, patient characteristics, and treatment modalities; and describes data regarding clinical indicators and preventive care, hospitalization, survival, and costs. The USRDS recently instituted a comprehensive assessment system to characterize the transition to the new Centers for Medicare & Medicaid Services Prospective Payment System, which bundles into a single payment several integral components of dialysis care. This challenging initiative will be an important component of future USRDS Annual Data Reports. The main strengths of the USRDS are its size and representativeness, nearly complete inclusion of the US end-stage renal disease population, and linkage to Medicare claims. Limitations include lack of continuous validation of its methods, lack of complete comorbidity and laboratory data at registration, an initial survival bias, and lack of accuracy of cause-of-death reporting.
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            Epidemiology of haemodialysis catheter complications: a survey of 865 dialysis patients from 14 haemodialysis centres in Henan province in China

            Objectives To investigate the incidence rates and risk factors for catheter-related complications in different districts and populations in Henan Province in China. Design Cross-sectional. Setting Fourteen hospitals in Henan Province. Participants 865 patients with renal dysfunction undergoing dialysis using catheters between October 2013 and October 2014. Main outcome measures The main outcome measures were complications, risk factors and patient characteristics. Catheter-related complications included catheter-related infection (catheter exit-site infection, catheter tunnel infection and catheter-related bloodstream infection), catheter dysfunction (thrombosis, catheter malposition or kinking, and fibrin shell formation) and central vein stenosis. Results The overall incidence rate was 7.74/1000 catheter-days, affecting 38.61% of all patients, for catheter infections, 10.58/1000 catheter-days, affecting 56.65% of all patients, for catheter dysfunction, and 0.68/1000 catheter-days, affecting 8.79% of all patients, for central vein stenosis. Multivariate analysis showed that increased age, diabetes, primary educational level or below, rural residence, lack of a nephropathy visit before dialysis and pre-established permanent vascular access, not taking oral drugs to prevent catheter thrombus, lower serum albumin levels and higher ferritin levels were independently associated with catheter infections. Rural residence, not taking oral drugs to prevent thrombus, lack of an imaging examination after catheter insertion, non-tunnel catheter type, lack of medical insurance, lack of nephropathy visit before dialysis and pre-established permanent vascular access, left-sided catheter position, access via the femoral vein and lower haemoglobin level were independently associated with catheter dysfunction. Diabetes, lack of nephropathy visit before dialysis and pre-established permanent vascular access, lack of oral drugs to prevent catheter thrombus, left-sided catheter location and higher number of catheter insertions, were independently associated with central vein stenosis. Conclusions The rate of catheter-related complications was high in patients with end-stage renal disease in Henan Province. Our finding suggest that strategies should be implemented to decrease complication rates.
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              A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters.

              Despite the US Dialysis Outcome Quality Initiative )DOQI( guidelines, for various reasons, increasing numbers of end-stage renal disease patients are becoming dependent on cuffed haemodialysis catheters (HCs) for chronic haemodialysis access. Their use is complicated by frequent failure due to thrombosis and catheter-related sepsis. In our unit, all HCs are put in place by the radiology department. In a prospective study we looked at the outcome of all HCs over a three-year period, during which time 573 consecutive HCs were placed in 336 patients. Each line was followed individually until it was removed or until the end of the study. In a survival analysis of those HCs removed following HC failure, HC half-life was 312 days and one-year HC survival was 47.5%. The most frequent indications for HC removal were non-function (36.6%), clinical suspicion of line sepsis (16.4%) and patient death (14.4%). Using a Cox proportional hazards model, catheter number in a given patient and the presence of diabetes mellitus were found to be independent predictors of HC failure. The total incidence of HC-related sepsis was 1.3 episodes/1000 catheter days. The probability of developing bacteraemic HC-related sepsis was 27.5% at one year. Less than half of the HCs were removed electively because of availability of a more permanent mode of renal replacement, thereby illustrating the level of dependence that has developed on them as permanent access. Consequently, their limitations (infection and malfunction) are placing an ever increasing burden on the healthcare services.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                22 April 2019
                April 2019
                : 11
                : 4
                : e4521
                Affiliations
                [1 ] Radiology, Dr Ziauddin University Hospital, Karachi, PAK
                [2 ] Radiology, Shaheed Mohtarma Benazir Bhutto Accident Emergency & Trauma Center, Civil Hospital, Karachi, PAK
                [3 ] Radiology, The Indus Hospital, Karachi, PAK
                Author notes
                Syed Muhammad Shahnawaz Hyder drshahni_80@ 123456yahoo.com
                Article
                10.7759/cureus.4521
                6590860
                7356ccdd-6df4-436e-a278-ca659c809a16
                Copyright © 2019, Hyder et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 April 2019
                : 22 April 2019
                Categories
                Radiology

                vascular access,permcath,complication,hemodialysis,end-stage-renal-disease

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