Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Oct 26;10(10):CD011953.
doi: 10.1002/14651858.CD011953.pub2.

Interventions for treating central venous haemodialysis catheter malfunction

Alice L Kennard  1 , Giles D Walters, Simon H Jiang, Girish S Talaulikar
Affiliations
Review

Interventions for treating central venous haemodialysis catheter malfunction

Alice L Kennard et al. Cochrane Database Syst Rev. .

Abstract

Background: Adequate haemodialysis (HD) in people with end-stage kidney disease (ESKD) is reliant upon establishment of vascular access, which may consist of arteriovenous fistula, arteriovenous graft, or central venous catheters (CVC). Although discouraged due to high rates of infectious and thrombotic complications as well as technical issues that limit their life span, CVC have the significant advantage of being immediately usable and are the only means of vascular access in a significant number of patients. Previous studies have established the role of thrombolytic agents (TLA) in the prevention of catheter malfunction. Systematic review of different thrombolytic agents has also identified their utility in restoration of catheter patency following catheter malfunction. To date the use and efficacy of fibrin sheath stripping and catheter exchange have not been evaluated against thrombolytic agents.

Objectives: This review aimed to evaluate the benefits and harms of TLA, preparations, doses and administration as well as fibrin-sheath stripping, over-the-wire catheter exchange or any other intervention proposed for management of tunnelled CVC malfunction in patients with ESKD on HD.

Search methods: We searched the Cochrane Kidney and Transplant Specialised Register up to 17 August 2017 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov.

Selection criteria: We included all studies conducted in people with ESKD who rely on tunnelled CVC for either initiation or maintenance of HD access and who require restoration of catheter patency following late-onset catheter malfunction and evaluated the role of TLA, fibrin sheath stripping or over-the-wire catheter exchange to restore catheter function. The primary outcome was be restoration of line patency defined as ≥ 300 mL/min or adequate to complete a HD session or as defined by the study authors. Secondary outcomes included dialysis adequacy and adverse outcomes.

Data collection and analysis: Two authors independently assessed retrieved studies to determine which studies satisfy the inclusion criteria and carried out data extraction. Included studies were assessed for risk of bias. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using GRADE.

Main results: Our search strategy identified 8 studies (580 participants) as eligible for inclusion in this review. Interventions included: thrombolytic therapy versus placebo (1 study); low versus high dose thrombolytic therapy (1); alteplase versus urokinase (1); short versus long thrombolytic dwell (1); thrombolytic therapy versus percutaneous fibrin sheath stripping (1); fibrin sheath stripping versus over-the-wire catheter exchange (1); and over-the-wire catheter exchange versus exchange with and without angioplasty sheath disruption (1). No two studies compared the same interventions. Most studies had a high risk of bias due to poor study design, broad inclusion criteria, low patient numbers and industry involvement.Based on low certainty evidence, thrombolytic therapy may restore catheter function when compared to placebo (149 participants: RR 4.05, 95% CI 1.42 to 11.56) but there is no data available to suggest an optimal dose or administration method. The certainty of this evidence is reduced due to the fact that it is based on only a single study with wide confidence limits, high risk of bias and imprecision in the estimates of adverse events (149 participants: RR 2.03, 95% CI 0.38 to 10.73).Based on the available evidence, physical disruption of a fibrin sheath using interventional radiology techniques appears to be equally efficacious as the use of a pharmaceutical thrombolytic agent for the immediate management of dysfunctional catheters (57 participants: RR 0.92, 95% CI 0.80 to 1.07).Catheter patency is poor following use of thrombolytic agents with studies reporting median catheter survival rates of 14 to 42 days and was reported to improve significantly by fibrin sheath stripping or catheter exchange (37 participants: MD -27.70 days, 95% CI -51.00 to -4.40). Catheter exchange was reported to be superior to sheath disruption with respect to catheter survival (30 participants: MD 213.00 days, 95% CI 205.70 to 220.30).There is insufficient evidence to suggest any specific intervention is superior in terms of ensuring either dialysis adequacy or reduced risk of adverse events.

Authors' conclusions: Thrombolysis, fibrin sheath disruption and over-the-wire catheter exchange are effective and appropriate therapies for immediately restoring catheter patency in dysfunctional cuffed and tunnelled HD catheters. On current data there is no evidence to support physical intervention over the use of pharmaceutical agents in the acute setting. Pharmacological interventions appear to have a bridging role and long-term catheter survival may be improved by fibrin sheath disruption and is probably superior following catheter exchange. There is no evidence favouring any of these approaches with respect to dialysis adequacy or risk of adverse events.The current review is limited by the small number of available studies with limited numbers of patients enrolled. Most of the studies included in this review were judged to have a high risk of bias and were potentially influenced by pharmaceutical industry involvement.Further research is required to adequately address the question of the most efficacious and clinically appropriate technique for HD catheter dysfunction.

PubMed Disclaimer

Conflict of interest statement

  1. Alice Kennard: none known

  2. Girish Talaulikar: none known

  3. Giles Walters: none known

  4. Simon Jiang: none known

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Thrombolytic therapy versus placebo, Outcome 1 Treatment success.
1.2
1.2. Analysis
Comparison 1 Thrombolytic therapy versus placebo, Outcome 2 Adverse events.
2.1
2.1. Analysis
Comparison 2 Low versus high dose thrombolytic, Outcome 1 Treatment success.
3.1
3.1. Analysis
Comparison 3 Alteplase versus urokinase, Outcome 1 Treatment success.
3.2
3.2. Analysis
Comparison 3 Alteplase versus urokinase, Outcome 2 Catheter survival.
3.3
3.3. Analysis
Comparison 3 Alteplase versus urokinase, Outcome 3 Adverse events.
4.1
4.1. Analysis
Comparison 4 Short versus long thrombolytic dwell, Outcome 1 Treatment success.
4.2
4.2. Analysis
Comparison 4 Short versus long thrombolytic dwell, Outcome 2 Catheter patency at 2 weeks.
5.1
5.1. Analysis
Comparison 5 Thrombolytic push versus thrombolytic dwell, Outcome 1 Treatment success.
5.2
5.2. Analysis
Comparison 5 Thrombolytic push versus thrombolytic dwell, Outcome 2 Change in Kt/V.
6.1
6.1. Analysis
Comparison 6 Fibrin sheath stripping versus thrombolytic therapy, Outcome 1 Treatment success.
6.2
6.2. Analysis
Comparison 6 Fibrin sheath stripping versus thrombolytic therapy, Outcome 2 Adverse events.
7.1
7.1. Analysis
Comparison 7 Fibrin sheath stripping versus over‐the‐wire catheter exchange, Outcome 1 Treatment success.
7.2
7.2. Analysis
Comparison 7 Fibrin sheath stripping versus over‐the‐wire catheter exchange, Outcome 2 Adverse events.
7.3
7.3. Analysis
Comparison 7 Fibrin sheath stripping versus over‐the‐wire catheter exchange, Outcome 3 Catheter survival.
8.1
8.1. Analysis
Comparison 8 Sheath disruption versus exchange alone, Outcome 1 Catheter survival.
8.2
8.2. Analysis
Comparison 8 Sheath disruption versus exchange alone, Outcome 2 Clearance in URR.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011953

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Donati 2012 {published data only}
    1. Donati G, Coli L, Cianciolo G, Manna G, Cuna V, Montanari M, et al. Thrombosis of tunneled‐cuffed hemodialysis catheters: treatment with high‐dose urokinase lock therapy. Artificial Organs 2012;36(1):21‐8. [MEDLINE: ] - PubMed
Gray 2000 {published data only}
    1. Gray RJ, Levitin A, Buck D, Brown LC, Sparling YH, Jablonski KA, et al. Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well‐positioned tunneled central venous dialysis catheters: a prospective, randomized trial. Journal of Vascular & Interventional Radiology 2000;11(9):1121‐9. [MEDLINE: ] - PubMed
MacRae 2005 {published data only}
    1. MacRae JM, Loh G, Shalansky S, Kiaii M. A randomized trial comparing two modalities of alteplase (TPA) administration on patency of hemodialysis catheters [abstract no: SA‐FC170]. Journal of the American Society of Nephrology 2002;13(September, Program & Abstracts):35A. [CENTRAL: CN‐00446527]
    1. Macrae JM, Loh G, Djurdjev O, Shalansky S, Werb R, Levin A, et al. Short and long alteplase dwells in dysfunctional hemodialysis catheters. Hemodialysis International 2005;9(2):189‐95. [MEDLINE: ] - PubMed
Merport 2000 {published data only}
    1. Merport M, Murphy TP, Egglin TK, Dubel GJ. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. Journal of Vascular & Interventional Radiology 2000;11(9):1115‐20. [MEDLINE: ] - PubMed
Oliver 2007 {published data only}
    1. Oliver MJ, Mendelssohn DC, Quinn RR, Richardson EP, Rajan DK, Pugash RA, et al. Catheter patency and function after catheter sheath disruption: a pilot study. Clinical Journal of the American Society of Nephrology: CJASN 2007;2(6):1201‐6. [MEDLINE: ] - PubMed
Pollo 2016 {published data only}
    1. Pollo V, Dionizio D, Bucuvic EM, Castro JH, Ponce D. Alteplase vs. urokinase for occluded hemodialysis catheter: a randomized trial. Hemodialysis International 2016;20(3):378‐84. [MEDLINE: ] - PubMed
TROPICS 3 Study 2010 {published data only}
    1. Goldman J, Fishbane S, Oliver MJ, Blaney M, Jacobs JR, Begelman SM. Tenecteplase for the improvement of blood flow rate in dysfunctional hemodialysis catheters. Clinical Nephrology 2012;77(1):55‐61. [MEDLINE: ] - PubMed
    1. Goldman J, Fishbane S, Oliver MJ, Blaney M, Jacobs JR, Begelman SM. Tenecteplase for the improvement of blood flow rate in dysfunctional hemodialysis catheters [abstract no: 110]. American Journal of Kidney Diseases 2010;55(4):A59. [EMBASE: 70124767] - PubMed
    1. Tumlin J, Goldman J, Spiegel D, Roer D, Ntoso K, Blaney M, et al. A phase III, randomized, double‐blind, placebo‐controlled study of tenecteplase for improvement of hemodialysis catheter function: TROPICS 3 [abstract]. Journal of Vascular & Interventional Radiology 2010;21(2 Suppl 1):S59‐60. [EMBASE: 70767699] - PMC - PubMed
    1. Tumlin J, Goldman J, Spiegel DM, Roer D, Ntoso KA, Blaney M, et al. A phase III, randomized, double‐blind, placebo‐controlled study of tenecteplase for improvement of hemodialysis catheter function: TROPICS 3. Clinical Journal of the American Society of Nephrology: CJASN 2010;5(4):631‐6. [MEDLINE: ] - PMC - PubMed
Vercaigne 2012 {published data only}
    1. Vercaigne LM, Zacharias J, Bernstein KN. Alteplase for blood flow restoration in hemodialysis catheters: a multicenter, randomized, prospective study comparing "dwell" versus "push" administration. Clinical Nephrology 2012;78(4):287‐96. [MEDLINE: ] - PubMed

References to studies excluded from this review

Abraham 1997 {published data only}
    1. Abraham ML, Dillon JJ. Prophylactic urokinase, catheter blood flow and hemodialysis delivery. A prospective, randomized, double‐blind, crossover trial [abstract no: A0716]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):151A. [CENTRAL: CN‐00444094]
CATHEDIA Study 2008 {published data only}
    1. Parienti JJ, Megarbane B, Fischer MO, Lautrette A, Gazui N, Marin N, et al. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Critical Care Medicine 2010;38(4):1118‐25. [MEDLINE: ] - PubMed
Coli 2006 {published data only}
    1. Coli L, Donati G, Cianciolo G, Raimondi C, Comai G, Panicali L, et al. Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters (TCC) thrombosis. Journal of Vascular Access 2006;7(3):118‐22. [MEDLINE: ] - PubMed
Dahlberg 1986 {published data only}
    1. Dahlberg PJ, Yutuc WR, Newcomer KL. Subclavian hemodialysis catheter infections. American Journal of Kidney Diseases 1986;7(5):421‐7. [MEDLINE: ] - PubMed
Geron 2008 {published data only}
    1. Geron R, Tanhilevsky O, Tanasijitchouk T, Rubinchik I, Kristal B. Addition of heparin to taurolockTM catheter lock solution (CLS) ‐ does it improve tunnel cuffed catheter (TCC) patency dysfunction? [abstract no: F‐PO1597]. Journal of the American Society of Nephrology 2008;19(Abstracts Issue):466A.
Gittins 2007 {published data only}
    1. Gittins NS, Hunter‐Blair YL, Matthews JN, Coulthard MG. Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: a randomised controlled trial. Archives of Disease in Childhood 2007;92(6):499‐501. [MEDLINE: ] - PMC - PubMed
Haire 2004 {published data only}
    1. Haire WD, Deitcher SR, Mullane KM, Jaff MR, Firszt CM, Schulz GA, et al. Recombinant urokinase for restoration of patency in occluded central venous access devices. A double‐blind, placebo‐controlled trial. Thrombosis & Haemostasis 2004;92(3):575‐82. [MEDLINE: ] - PubMed
ISRCTN00873351 {published data only}
    1. Makanjuola D. Comparison of the fibrin analysis system (FAS) endoluminal brush with currently accepted practice for restoring patency to blocked or partially blocked haemodialysis catheters. controlled‐trials.com/ISRCTN00873351 (first received 30 September 2005).
Kaneko 2004 {published data only}
    1. Kaneko Y, Iwano M, Yoshida H, Kosuge M, Ito S, Narita I, et al. Natural saline‐flush is sufficient to maintain patency of immobilized‐urokinase double‐lumen catheter used to provide temporary blood access for hemodialysis. Blood Purification 2004;22(5):473‐9. [MEDLINE: ] - PubMed
Khosroshahi 2015 {published data only}
    1. Khosroshahi HT, Mahdipur H, Parkhideh S, Basmenji S, Khalilzadeh M, Tozihi M. The effectiveness of systemic antibiotic therapy with and without ethanol‐locked solution in the treatment of hemodialysis‐related catheter infection. Saudi Journal of Kidney Diseases & Transplantation 2015;26(3):477‐81. [MEDLINE: ] - PubMed
Klouche 2007 {published data only}
    1. Klouche K, Amigues L, Deleuze S, Beraud JJ, Canaud B. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure. American Journal of Kidney Diseases 2007;49(1):99‐108. [MEDLINE: ] - PubMed
Li 2014d {published data only}
    1. Li X, Liu D, Wang Y, Wang M, Zhang J, Guo Y. Efficacy and safety of early use of urokinase for prevention and treatment of tunneled hemodialysis catheter‐related fibrin sheaths. Nan Fang Yi Ke Da Xue Xue Bao [Journal of Southern Medical University] 2014;34(11):1668‐71. [MEDLINE: ] - PubMed
Mokrzycki 2001 {published data only}
    1. Mokrzycki MH, Jean‐Jerome K, Rush H, Zdunek MP, Rosenberg SO. A randomized trial of minidose warfarin for the prevention of late malfunction in tunneled, cuffed hemodialysis catheters. Kidney International 2001;59(5):1935‐42. [MEDLINE: ] - PubMed
    1. Mokrzycki MH, Rush H, Jean‐Jerome K, Zdunek MP, Rosenberg SO. Risk factors for late malfunction in tunneled‐cuffed hemodialysis catheters and the efficacy of fixed, mini‐dose warfarin [abstract]. Journal of the American Society of Nephrology 2000;11(Sept):190‐1A. [CENTRAL: CN‐00626099]
Mokrzycki 2006 {published data only}
    1. Mokrzycki M, Rosenberg S, Golestaneh L, Zhang M, Jeffrey L. A quality improvement initiative for the management of tunneled cuffed hemodialysis catheter (TCC) bacteremia [abstract no: SA‐FC141]. Journal of the American Society of Nephrology 2005;16:112A. [CENTRAL: CN‐00583542]
    1. Mokrzycki MH, Zhang M, Golestaneh L, Laut J, Rosenberg SO. An interventional controlled trial comparing 2 management models for the treatment of tunneled cuffed catheter bacteremia: a collaborative team model versus usual physician‐managed care. American Journal of Kidney Diseases 2006;48(4):587‐95. [MEDLINE: ] - PubMed
NCT00194181 {published data only}
    1. Stavropoulos SW. Randomized prospective trial of Rt‐PA infusion versus catheter exchange for treatment of dialysis catheter malfunction due to fibrin sheath formation. www.clinicaltrials.gov/ct2/show/NCT00194181 (first received 12 September 2005).
Pervez 2002 {published data only}
    1. Pervez A, Ahmed M, Ram S, Torres C, Work J. Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia (CAB) [abstract]. Journal of the American Society of Nephrology 2000;11(Sept):194A. - PubMed
    1. Pervez A, Ahmed M, Ram S, Torres C, Work J, Zaman F, et al. Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia. Journal of Vascular Access 2002;3(3):108‐13. [MEDLINE: ] - PubMed

References to studies awaiting assessment

Hammes 2001 {published data only}
    1. Hammes M, Ferrell J, Poduval R. Prospective, randomized, double‐blind study of the safety, efficacy and therapeutic dose of alteplase (t‐PA) in the treatment of occluded hemodialysis catheters [abstract]. American Journal of Kidney Diseases 2002;39(4):A18. [CENTRAL: CN‐00401211]
    1. Hammes MS, Ferrell J, Poduval RD. Intraluminal alteplase (t‐PA) is an effective means to treat occluded hemodialysis (HD) catheters [abstract]. Journal of the American Society of Nephrology 2001;12(Program & Abstracts):290A. [CENTRAL: CN‐00445629]
Xue 2010 {published data only}
    1. Xue ZQ, Zeng SY. Effects of urokinase 24 hours dwelling‐lock thrombolysis treatment on thrombosis in double lumen catheter indwelling in internal jugular vein for dialysis. Chinese Journal of Blood Purification 2010;5(5):265‐8.

Additional references

Alomari 2007
    1. Alomari AI, Falk A. The natural history of tunneled hemodialysis catheters removed or exchanged: a single‐institution experience. Journal of Vascular & Interventional Radiology 2007;18(2):227‐35. [MEDLINE: ] - PubMed
Atherikul 1998
    1. Atherikul K, Schwab SJ, Conlon PJ. Adequacy of haemodialysis with cuffed central‐vein catheters. Nephrology Dialysis Transplantation 1998;13(3):745‐9. [MEDLINE: ] - PubMed
Atkinson 1990
    1. Atkinson JB, Bagnall HA, Gomperts E. Investigational use of tissue plasminogen activator (t‐PA) for occluded central venous catheters. Jpen: Journal of Parenteral & Enteral Nutrition 1990;14(3):310‐1. [MEDLINE: ] - PubMed
CDC Report 2011
    1. Centers for Disease Control and Prevention (CDC). Vital signs: central line‐associated blood stream infections‐‐United States, 2001, 2008, and 2009. MMWR ‐ Morbidity & Mortality Weekly Report 2011;60(8):243‐8. [MEDLINE: ] - PubMed
Clase 2001
    1. Clase CM, Crowther MA, Ingram AJ, Cina CS. Thrombolysis for restoration of patency to haemodialysis central venous catheters: a systematic review. Journal of Thrombosis & Thrombolysis 2001;11(2):127‐36. [MEDLINE: ] - PubMed
D'Cunha 2004
    1. D'Cunha PT, Besarab A. Vascular access for hemodialysis: 2004 and beyond. Current Opinion in Nephrology & Hypertension 2004;13(6):623‐9. [MEDLINE: ] - PubMed
Daniels 2013
    1. Daniels KR, Frei CR. The United States' progress toward eliminating catheter‐related bloodstream infections: incidence, mortality, and hospital length of stay from 1996 to 2008. American Journal of Infection Control 2013;41(2):118‐21. [MEDLINE: ] - PubMed
Di Iorio 2004
    1. Iorio BR, Bellizzi V, Cillo N, Cirillo M, Avella F, Andreucci VE, et al. Vascular access for hemodialysis: the impact on morbidity and mortality. Journal of Nephrology 2004;17(1):19‐25. [MEDLINE: ] - PubMed
Ethier 2008
    1. Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study.[Erratum appears in Nephrol Dial Transplant. 2008 Dec;23(12):4088]. Nephrology Dialysis Transplantation 2008;23(10):3219‐26. [MEDLINE: ] - PMC - PubMed
Fadrowski 2006
    1. Fadrowski JJ, Hwang W, Frankenfield DL, Fivush BA, Neu AM, Furth SL. Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the Clinical Performance Measures and US Renal Data System projects. Clinical Journal of The American Society of Nephrology: CJASN 2006;1(5):987‐92. [MEDLINE: ] - PubMed
Faintuch 2008
    1. Faintuch S, Salazar GM. Malfunction of dialysis catheters: management of fibrin sheath and related problems. Techniques in Vascular & Interventional Radiology 2008;11(3):195‐200. [MEDLINE: ] - PubMed
GRADE 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. [MEDLINE: ] - PMC - PubMed
Hemmelgarn 2011
    1. Hemmelgarn BR, Moist LM, Lok CE, Tonelli M, Manns BJ, Holden RM, et al. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. New England Journal of Medicine 2011;364(4):303‐12. [MEDLINE: ] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [MEDLINE: ] - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hilleman 2011
    1. Hilleman D, Campbell J. Efficacy, safety, and cost of thrombolytic agents for the management of dysfunctional hemodialysis catheters: a systematic review. Pharmacotherapy: The Journal of Human Pharmacology & Drug Therapy 2011;31(10):1031‐40. [MEDLINE: ] - PubMed
Ishani 2005
    1. Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney International 2005;68(1):311‐8. [MEDLINE: ] - PubMed
Karaaslan 2001
    1. Karaaslan H, Peyronnet P, Benevent D, Lagarde C, Rince M, Leroux‐Robert C. Risk of heparin lock‐related bleeding when using indwelling venous catheter in haemodialysis. Nephrology Dialysis Transplantation 2001;16(10):2072‐4. [MEDLINE: ] - PubMed
KDOQI Guidelines 2006
    1. National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. American Journal of Kidney Diseases 2006;48(Suppl 1):S1‐S322.
Kinney 2006
    1. Centers for Medicare and Medicaid Services, Kinney R. 2005 Annual Report: ESRD Clinical Performance Measures Project. American Journal of Kidney Diseases 2006;48(4 Suppl 2):S1‐106. [MEDLINE: ] - PubMed
Klevens 2007
    1. Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care‐associated infections and deaths in U.S. hospitals, 2002. Public Health Reports 2007;122(2):160‐6. [MEDLINE: ] - PMC - PubMed
Kukavica 2009
    1. Kukavica N, Resic H, Sahovic V. Comparison of complications and dialysis adequacy between temporary and permanent tunnelled catheter for haemodialysis. Bosnian Journal of Basic Medical Sciences 2009;9(4):265‐70. [MEDLINE: ] - PMC - PubMed
Lee 2005
    1. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. American Journal of Kidney Diseases 2005;46(3):501‐8. [MEDLINE: ] - PubMed
Little 2001
    1. Little MA, O'Riordan A, Lucey B, Farrell M, Lee M, Conlon PJ, et al. A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters. Nephrology Dialysis Transplantation 2001;16(11):2194‐200. [MEDLINE: ] - PubMed
Lok 2006
    1. Lok CE, Thomas A, Vercaigne L, Canadian Hemodialysis Catheter Working Group. A patient‐focused approach to thrombolytic use in the management of catheter malfunction. Seminars in Dialysis 2006;19(5):381‐90. [MEDLINE: ] - PubMed
Lok 2007
    1. Lok CE. Fistula first initiative: advantages and pitfalls. Clinical Journal of The American Society of Nephrology: CJASN 2007;2(5):1043‐53. [MEDLINE: ] - PubMed
Lopes 2007
    1. Lopes AA, Bragg‐Gresham JL, Goodkin DA, Fukuhara S, Mapes DL, Young EW, et al. Factors associated with health‐related quality of life among hemodialysis patients in the DOPPS.[Erratum appears in Qual Life Res. 2007 Aug;16(6):1095]. Quality of Life Research 2007;16(4):545‐57. [MEDLINE: ] - PubMed
Macrae 2005
    1. Macrae JM, Loh G, Djurdjev O, Shalansky S, Werb R, Levin A, et al. Short and long alteplase dwells in dysfunctional hemodialysis catheters. Hemodialysis International 2005;9(2):189‐95. [MEDLINE: ] - PubMed
Manns 2014
    1. Manns BJ, Scott‐Douglas N, Tonelli M, Ravani P, LeBlanc M, Dorval M, et al. An economic evaluation of rt‐PA locking solution in dialysis catheters. Journal of the American Society of Nephrology 2014;25(12):2887‐95. [MEDLINE: ] - PMC - PubMed
Mendelssohn 2006
    1. Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL. Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrology Dialysis Transplantation 2006;21(3):721‐8. [MEDLINE: ] - PubMed
Mokrzycki 2010
    1. Mokrzycki MH, Lok CE. Traditional and non‐traditional strategies to optimize catheter function: go with more flow. Kidney International 2010;78(12):1218‐31. [MEDLINE: ] - PubMed
Polkinghorne 2003
    1. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Epidemiology of vascular access in the Australian hemodialysis population. Kidney International 2003;64(5):1893‐902. [MEDLINE: ] - PubMed
Polkinghorne 2004
    1. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all‐cause mortality: a propensity score analysis. Journal of the American Society of Nephrology 2004;15(2):477‐86. [MEDLINE: ] - PubMed
Rayner 2004
    1. Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL. Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. American Journal of Kidney Diseases 2004;44(5 Suppl 2):22‐6. [MEDLINE: ] - PubMed
Renaud 2015
    1. Renaud CJ, Lim EK, Tho SJ, Yeoh LY. Effect of ultra‐low dose and standard heparin locks on early tunnelled dialysis catheter outcomes in low‐risk dialysis patients. Nephrology 2015;20(2):85‐90. [MEDLINE: ] - PubMed
Rijken 2009
    1. Rijken DC, Lijnen HR. New insights into the molecular mechanisms of the fibrinolytic system. Journal of Thrombosis & Haemostasis 2009;7(1):4‐13. [MEDLINE: ] - PubMed
Schünemann 2011a
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Schünemann 2011b
    1. Schünemann HJ, Oxman AD, Higgins JP, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Swartz 1994
    1. Swartz RD, Messana JM, Boyer CJ, Lunde NM, Weitzel WF, Hartman TL. Successful use of cuffed central venous hemodialysis catheters inserted percutaneously. Journal of the American Society of Nephrology 1994;4(9):1719‐25. [MEDLINE: ] - PubMed
Thomson 2010
    1. Thomson P, Stirling C, Traynor J, Morris S, Mactier R. A prospective observational study of catheter‐related bacteraemia and thrombosis in a haemodialysis cohort: univariate and multivariate analyses of risk association. Nephrology Dialysis Transplantation 2010;25(5):1596‐604. [MEDLINE: ] - PubMed
Trerotola 1997
    1. Trerotola SO, Johnson MS, Harris VJ, Shah H, Ambrosius WT, McKusky MA, et al. Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologists. Radiology 1997;203(2):489‐95. [MEDLINE: ] - PubMed
Tumlin 2010
    1. Tumlin J, Goldman J, Spiegel DM, Roer D, Ntoso KA, Blaney M, et al. A phase III, randomized, double‐blind, placebo‐controlled study of tenecteplase for improvement of hemodialysis catheter function: TROPICS 3. Clinical Journal of The American Society of Nephrology: CJASN 2010;5(4):631‐6. [MEDLINE: ] - PMC - PubMed
Vascular Access Guidelines 2006
    1. Vascular Access Work Group. Clinical practice guidelines for vascular access. American Journal of Kidney Diseases 2006;48 Suppl 1:S248‐73. [MEDLINE: ] - PubMed
Wang 2013
    1. Wang AY, Ivany JN, Perkovic V, Gallagher MP, Jardine MJ. Anticoagulant therapies for the prevention of intravascular catheters malfunction in patients undergoing haemodialysis: systematic review and meta‐analysis of randomized, controlled trials.[Erratum appears in Nephrol Dial Transplant. 2013 Dec;28(12):3127]. Nephrology Dialysis Transplantation 2013;28(11):2875‐88. [MEDLINE: ] - PubMed
Wasse 2007
    1. Wasse H, Speckman RA, Frankenfield DL, Rocco MV, McClellan WM. Predictors of delayed transition from central venous catheter use to permanent vascular access among ESRD patients. American Journal of Kidney Diseases 2007;49(2):276‐83. [MEDLINE: ] - PMC - PubMed
Xue 2013
    1. Xue H, Ix JH, Wang W, Brunelli SM, Lazarus M, Hakim R, et al. Hemodialysis access usage patterns in the incident dialysis year and associated catheter‐related complications. American Journal of Kidney Diseases 2013;61(1):123‐30. [MEDLINE: ] - PMC - PubMed

References to other published versions of this review

Kennard 2015
    1. Kennard AL, Walters GD, Jiang SH, Talaulikar GS. Interventions for treating central venous haemodialysis catheter malfunction. Cochrane Database of Systematic Reviews 2015, Issue 11. [DOI: 10.1002/14651858.CD011953] - DOI - PMC - PubMed