Abstract: TH-PO272
Tunnelled Central Venous Haemodialysis Catheter Tip Design and Risk of Catheter Dysfunction
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Lazarus, Ben, Monash University, Clayton, Victoria, Australia
- Polkinghorne, Kevan, Monash University, Clayton, Victoria, Australia
- Coggan, Sarah E., The George Institute for Global Health, Newtown, New South Wales, Australia
- Gray, Nicholas A., Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- Talaulikar, Girish S., Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Gallagher, Martin P., The George Institute for Global Health, Newtown, New South Wales, Australia
- Kotwal, Sradha S., The George Institute for Global Health, Newtown, New South Wales, Australia
Group or Team Name
- on behalf of the REDUCCTION investigators
Background
It is unknown whether the design of the tunnelled haemodialysis catheter (TCVC) tip influences the risk of catheter dysfunction. In small, randomized controlled trials symmetrical tip catheters have favourable rheology compared to step-tip catheters. We aimed to determine whether TCVC tip design influences the risk of catheter dysfunction requiring removal.
Methods
We conducted a post-hoc analysis using data from the REDUcing the burden of dialysis Catheter ComplicaTIOns study (2016-2020). TCVC were classified into three distinct designs: symmetrical, step or split tips. Non-tunnelled catheters were excluded as were TCVC with missing tip design (n=945), and those with missing reason for removal (n=267) leaving 6209 TCVC in 4652 participants. The primary outcome was time to catheter removal due to poor flow as assessed by the treating clinician. Death and other reasons for catheter removal were considered competing events. We compared the risk of catheter dysfunction across different catheter tip designs using raw proportions and a multivariable Fine and Gray model with robust cluster variance estimators for clustering by service.
Results
Overall, 354 of 3881 (9.1%), 258 of 1873 (13.8%), and 39 of 455 (8.6%) TCVC with symmetrical, step and split tip designs respectively, were removed for catheter dysfunction. Relative to catheters with a symmetrical tip, catheters with step tip had a 53% higher risk of catheter dysfunction, which persisted after multivariable adjustment (subdistribution hazard ratio = 1.53, 95% CI: 1.24 – 1.89). No difference was observed for split tip catheters (sHR = 0.66, 95% CI: 0.31 – 1.38).
Conclusion
Tunnelled HD CVCs with a step tip have a higher risk of dysfunction than those with a symmetrical tip. Prospective, large randomized controlled trials are warranted to confirm this observation.
Funding
- Government Support – Non-U.S.