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Abstract: PO1357

Are Rescue Maneuvers More Efficient for Tunneled Catheter Late Dysfunction Than Wire Guide Catheter Replacement?

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Murillo brambila, Daniel, PISA SANEFRO, Guadalajara, Jalisco, Mexico
  • Jimenez Cornejo, Monica Consuelo, PISA SANEFRO, Guadalajara, Jalisco, Mexico
  • Abundis Mora, Gabriela Jazmín, PISA SANEFRO, Guadalajara, Jalisco, Mexico
  • Renoirte, Karina, PISA SANEFRO, Guadalajara, Jalisco, Mexico
Background

Late catheter dysfunction is a common complication in HD patients. Complications associated with vascular accesses account for approximately 30% of hospital admissions for chronic HD patients. It also increases mortality. It is diagnosed when a catheter has been used successfully and later becomes dysfunctional. Thrombotic occlusion is the main cause. It is traditionally managed by placing a new catheter, wich may later lead to vascular access exhaustion.
The purpose of this study was to assess the efficacy and safety of rescue maneuvers to treat late dysfuntional tunneled catheters versus catheter replacement.

Methods

Prospective, observational study. 195 procedures were performed between 2018 and 2019 in patients with late tunneled catheter dysfunction. Patients were ramdomly assigned to one group: group A, high pressure saline solution infusion into both lumens until obtaining good patency (permeabilization); B, catheter tip mobilization to reposition catheter tip until obtaining good patency; C, wire guide catheter replacement. Variables analyzed: age, gender, CKD etiology, vascular access site at the time of dysfunction, patency after rescue maneuvers (days). Percentages, means, Kruskal Wallis and Kaplan Meir and chi-square test were used.

Results

118 were male (60.5%), with mean age of 51.2 years (17.3). CKD etiology was of unknown origin in 90 patients (46.2 %) and 52(26.7%) had diabetes mellitus. The right jugular vein was the most common anatomical site at the time of dysfunction (n=87, 44.8%). Catheter patency: group A, 119 days (99.3); group B, 175.4 days (175.5) and group C 217.6 days(157). Kruskal-Wallis test in the comparison between groups: group A vs B, p=0.8; C vs A, P=0.001; C vs B, p=0.057. The Kaplan Meir curve showed that group B and C had a longer catheter survival than A group (p=<0.001). Complications: six patients (3.1%) had bleeding from the catheter exit site in group C (p=0.015).

Conclusion

In late vascular catheter dysfunction, catheter tip mobilization is a rescue maneuver as effective as wire guide replacement tunneled catheter and with fewer complications.

Baseline characteristic-kruskal wallis test- kaplan meir curve