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. 2022 May 19;32(2):10537.
doi: 10.4081/ejtm.2022.10537.

May position of hemodialysis catheter tip have a direct effect on its patency? Positive results of a preliminary study on its rotation

Mohammad Hassani  1 , Mahdi Mohebbi  2 , Mehdi Tavallaei  3 , Seyed Mohammad Reza Hosseini Nodoushan  4 , Moein Mirzadeh  5 , Rana Hashemi  6
Affiliations

May position of hemodialysis catheter tip have a direct effect on its patency? Positive results of a preliminary study on its rotation

Mohammad Hassani et al. Eur J Transl Myol. .

Abstract

Renal transplant therapy is essential in patients with End-Stage Renal Disease (ESRD). It is used in patients awaiting a kidney transplant or those who cannot be a transplant candidate. Central venous catheter is one of the most used access routes worldwide but has been recorded as the one with highest mortality and morbidity rate. Thromboembolic events have played a major part for that. This is a descriptive-analytical study, which conducted in a university treatment center in Tehran, Iran. A total of 225 patients were selected for this study that 108 were excluded because of our criteria. Statistical analysis was performed by SPSS v19 and a total of 117 patients were included in this study. The average age of the patients was 51.62±11.26. 79 (67.5%) and 38 (32.5%) patients had medial and lateral tip direction, respectively. The catheter of 85(72.6%) and 32(27.4%) patients was patent and occluded, respectively. The average catheter tip occlusion time in both groups was 22.5 and 7.5 months. Three-month, six-month, twelve-month, and twenty-four-month patency rate were 99%, 94%, 88%, and 30%, respectively. our findings suggest that medial direction of the tip of the catheter reduces complications caused in CVS. Because our study has been conducted in a small scale and there is lack of similar studies, our team suggests extension to a larger scale to confirm or not our results.

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Conflict of interest statement

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Patients diagnosed with kidney failure formerly known as End-Stage Renal Disease (ESRD) or End- Stage Kidney Disease (ESKD) have a high incidence in the general population and their ultimate treatment would be a kidney transplantation. However, the majority of this patients (about 60%) who cannot be transplanted need other methods. On the other hand, even if a patient has the requirements for transplantation, before the procedure, the majority require hemodialysis (HM). Permcath is an alternative vascular accesses for those patients in wich arteriovenous fistula and graft or peritoneal dialysis are considered unsuitable for several reason (e.g. exhaustion of vascular bed, previous steal syndrome in functional AVF, severe hypotension)., However, several problems have emerged following the widespread use of permcaths. These include higher risks of central venous stenosis, increased morbidity for infection, catheter thrombosis,, with decreased dialysis adequacy due to lower blood flow rate. Thrombosis related to vascular access devices is common and has a significant impact on patient morbidity and mortality. Over time, fibrin sheet forms on the tip of catheters which leads to catheter lumen obstruction and loss of function. In fact, the most common reason of failure of dialysis catheters’ long-term function is the formation of fibrin sheath. However, the term “fibrin sheath” is inaccurate to describe these phenomena, because the sheath can be composed of thrombus, endothelial cells, and finally collagen, depending on the time length of the catheter placement in the body. Within a few weeks, collagen forms on the tip of the catheter as the smooth muscle cells of the venous wall migrate and the leukocytes adhere to the surface of the catheter creating a one-way valve mechanism (easy to inject, difficult to aspirate). It will also be associated with thrombosis and infection. Study of fluid dynamics, blood flow turbulence and local changes in the surface of the intravascular catheter can have a significant effect on preventing thrombosis and fibrin sheet formation. Given: i) the novelty of the idea; ii) the multiplicity of existing evidence; iii) the simplicity of modified surgical technique; iv) the potential of avoiding additional costs in the health sector; and v) the widespread use of step-tip catheters, our goal in this study is to answer whether the rotation of the dialysis catheter tip has or not a direct effect on its patency. Of course, in this study, standard locking solutions for systemic anticoagulation were also used to maintain catheter patency, i.e., sodium citrate (4%) or concentrated heparin solutions (1000 units per ml).

Figures

Figure 1.
Figure 1.
A: Step-tip hemodialysis catheter with medially tip placed in right internal jugular B: A hemodialysis catheter placed in left internal jugular, with laterally placed tip.
Figure 2.
Figure 2.
Standard Kaplan-Meier (KM) curve for end point of the study.
See this image and copyright information in PMC

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