Tunneled Femoral Vein Catheterization for Lengthy Time period Hemodialysis: A Single Heart Expertise Al-Hwiesh AK, Abdul-Rahaman IS

The effect of gabapentin on muscle cramps during hemodialysis: A double-blind clinical trial Beladi Mousavi SS, Zeraati A, Moradi S, Mousavi MB
May 5, 2021 0 Comments

   Summary  

Femoral veins have been used for many years to place short-term hemodialysis catheters. Few studies, nonetheless, describe its use for everlasting vascular entry. This examine describes the usage of tunneled femoral vein catheters as everlasting vascular accesses. Fourteen power hemodialysis sufferers (9 males and 5 females) had tunneled central venous catheters positioned within the femoral vein from November 2004 to July 2005. The age of the sufferers ranged from 21 to 68 years with a imply of 49.8 ± 5.9 years. Placement of a catheter through the interior jugular veins was unimaginable in 10 sufferers whose course was difficult by thrombosis or strictures of the superior vena cava. The remaining 4 sufferers had exhausted typical entry websites. The insertion of the femoral catheters concerned a subcutaneous tunnel that was created by retrograde passage of the catheter by way of the cannula to the purpose of exit at a preselected web site within the epsilateral thigh away from the groin. The life span of the tunneled femoral catheter ranged between 32-240 days; median time in place was 182 days. There have been 4 incidences of tunnel an infection with Pseudomonas aeruginosa, E. coli, and Streptococcus epidermidis, which have been handled efficiently with out the necessity for catheter elimination. Different problems reminiscent of bleeding, kinking, migration of the catheter, arterial puncture, retroperitoneal or femoral hematomas weren’t noticed. We conclude that tunneled femoral catheters are appropriate alternate options for long-term hemodialysis entry. Further research with a better pattern dimension are wanted to substantiate this conclusion.

Key phrases: Femoral vein, tunneled, an infection, thrombosis, hemodialysis

The best way to cite this text:
Al-Hwiesh AK, Abdul-Rahaman IS. Tunneled Femoral Vein Catheterization for Lengthy Time period Hemodialysis: A Single Heart Expertise. Saudi J Kidney Dis Transpl 2007;18:37-42

The best way to cite this URL:
Al-Hwiesh AK, Abdul-Rahaman IS. Tunneled Femoral Vein Catheterization for Lengthy Time period Hemodialysis: A Single Heart Expertise. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2021 May 5];18:37-42. Out there from: https://www.sjkdt.org/textual content.asp?2007/18/1/37/31843

   Introduction   Top

Blood stream infections are widespread and critical problems of central venous catheters used for hemodialysis. To lower catheter colonization, some physicians advocate tunneling the catheter within the subcutaneous tissue throughout insertion. This system has proved efficient in tunneled central catheters inserted in inside jugular and subclavian veins. [1],[2],[3]

Not too long ago, it has been discovered that the subclavian vein shouldn’t be used as a standard web site for catheter placement, since it’s related to a excessive incidence of vascular stenosis. [4],[5] Therefore, vascular entry by way of the interior jugular vein is changing into the primary alternative. Nonetheless, repeated makes an attempt at cervical and thoracic vein catheterization have been related in lots of sufferers with a considerably excessive incidence of problems reminiscent of arterial accidents, vascular thrombosis, infections, and hemothorax. In others, these repeated makes an attempt have left the sufferers with no various cervical or thoracic venous entry websites. The percutaneous insertion of a tunneled femoral catheter could also be an appropriate possibility in these chosen sufferers.

This examine describes the expertise of our heart with the usage of tunneled femoral vein catheters as everlasting vascular accesses.

   Strategies   Top

Fourteen power hemodialysis sufferers (9 males and 5 females) had tunneled central venous catheters positioned within the femoral vein from November 2004 to July 2005. The age of the sufferers ranged from 21 to 68 years with a median of 55 years (imply: 49.8 + 5.9). The sufferers’ traits are proven in [Table – 1].

All sufferers had initially obtained central strains through a subclavian vein, which have been eliminated both unintentionally or secondary to catheter obstruction or infectious problems. Placement of a brand new catheter through the interior jugular veins was im­doable in 10 sufferers who suffered from thrombosis or strictures of the superior vena cava. The remaining 4 sufferers had exhausted typical entry websites and no different choices have been left.

Polyurethane twin lumen tunneled catheters, 30 cm lengthy – 7 French with two 16-gauge channels – (Seldiflex, Plastimed, Saint Len, France) have been inserted utilizing the Seldinger methodology. Catheters have been inserted within the minor surgical procedure room beneath strict aseptic circumstances. The insertion web site was ready with povidone iodine or 0.5% chlorhexidine. The subcutaneous tunnel was long-established by retrograde passage of the catheter by way of the cannula to the purpose of exit at a preselected web site within the epsilateral thigh. The gap separating the cutaneous puncture web site from the venous entry needed to be approxi­mately 10 cm. Intravenous tubing and semi­permeable clear dressing (Opsite IV 3000, Smith and Nephew Med Ltd.,Hull, United Kingdom), have been modified routinely each 72 hours. Catheter dressings have been inspected by skilled nurses twice per week for the looks of native indicators of an infection. Blood sampling or administration of medicines weren’t permitted by way of the road. Catheter exit web site swabs and blood cultures have been collected on a weekly foundation. Blood move charge (as measured by pump pace), in addition to systolic and diastolic blood pressures have been recorded at half-hourly intervals throughout every hemodialysis session. Drop in blood move by better than or equal to twenty% beneath that prescribed within the absence of hypotension, hypovolemic episode, or affected person/catheter malposition was thought-about to be secondary to catheter malfunction. In all sufferers, blood move was stored at 300 ml/min or extra. A routine intradialytic heparin protocol was used.

   Outcomes   Top

The length of practical lifetime of the tunneled femoral catheter ranged between 32-240 days; median time and imply have been 182 and 149.3 + 13.8 days, respectively.

No problems occurred through the insertion process. One catheter needed to be eliminated after 86 days due to a profitable institution of an A-V fistula. One other catheter needed to be eliminated after 160 days due to catheter obstruction. The remaining 12 catheters functioned with out issues with a blood move of 300-350 ml/min throughout dialysis. There have been 4 incidences of tunnel an infection with Pseudomonas aeruginosa, E. coli, and Streptococcus epidermidis which have been handled efficiently with out the necessity for catheter elimination. In a single case, the process was difficult by femoral vein thrombosis related to E. coli bacteremia. Within the different 11 sufferers there have been no catheter­associated infectious problems. Different problems reminiscent of bleeding, kinking, migration of the catheter, arterial puncture, retroperitoneal or femoral hematomas weren’t noticed [Table – 2].

   Dialogue   Top

The femoral vein is the hemodialysis short-term entry web site of alternative by most nephrologists. Catheterization of the femoral vein is comparatively straightforward to carry out, protected and handy. In distinction to entry through the subclavian or inside jugular veins, which can contain life-threatening problems, there’s a comparatively low threat of insertion-related problems through the use of the femoral route[6]. The heart beat of the femoral artery serves as a landmark for the vein; within the case of bleeding, the vessel could be immediately compressed towards the arduous surfaces of the femur and the pelvis. Thrombosis or constructions of the superior vena cava could preclude placement of a central catheter through the interior jugular route. In such sufferers, insertion of tunneled femoral vein catheters would appear to be a rational various. Lazrus et al [7] reported on 5 grownup sufferers present process transplantation of autologous bone marrow in whom tunneled femoral central venous catheters have been positioned and remained in place for a median of 35 days. There have been two infectious problems that resolved with antibiotic remedy with out elimination of the catheter. [7] One other report was revealed regarding an grownup affected person who obtained high-dose chemotherapy and allogeneic peripheral blood stem cell transplantation through a femoral Hickman catheter for recurrent high-grade non­Hodgkin’s lymphoma; this catheter was efficiently used for 3 months. [8] Typical femoral vein catheterization has been ceaselessly related to infections due to fecal contamination. [9] An infection primarily originates from the pores and skin catheter junction, [10] particularly in catheters used for the quick time period; [11],[12],[13] that’s the reason it has been prompt that subcutaneous tunneling of the catheter may scale back the transmission of pathogens by growing the gap between the skin-catheter junction and the vein. In the meantime, the usage of tunneled catheters proved to be related to a three-fold lower in catheter-related sepsis. [14] An analogous conclusion has been reported by Timsit et al [15] in critically unwell sufferers. Though studies are conflicting, long-term cannulation of the femoral vessels for the aim of hemodialysis was believed to hold a better threat of an infection in comparison with non-femoral cannulation. [16], [17],[18],[19],[20],[21] Nonetheless, in a latest examine by Daniel, the incidence of catheter­associated infections with femoral catheters have been just like these beforehand reported with jugular catheters. [22] Within the current examine, the incidence of catheter-related web site infections and catheter -related bacteremia with tunneled femoral catheters was solely 28.6%, and seven.1%, respectively. Using subcutaneous tunneling to take away the exit web site of the catheter from the perineal space could have considerably decreased the danger of an infection. One other rationalization is the low incidence of thrombosis in our sufferers, as there’s an affiliation of thrombosis and sepsis. [23],[24],[25] As well as the comparatively quick length of the catheter in place (imply 149.3 + 13.8 days) could have contributed to the low incidence of catheter-related thrombosis in our collection, as earlier research[26],[27],[28] have proven that thrombosis often happens after a median of seven weeks. For a few years, insufficient supply of blood move for dialysis has been a constant concern. Insufficient blood move could be divided into acute and power phases: acutely diminished move could also be because of systemic hypotension, catheter malpositioning, or different mechanical issues. Whereas diminished move occurring later could also be because of thrombosis or formation of a fibrin sheath, along with mechanical issues. [29]

Till not too long ago, blood move charges beneath 200 ml/min have been usually thought-about insufficient; nonetheless, the DOQI tips raised the usual for blood move charges by suggesting a minimal move charge of 300 ml/min.[30] In our examine we didn’t encounter difficulties in reaching this purpose. We conclude that tunneled femoral catheters are appropriate alternate options for long-term hemodialysis entry. Further research with bigger pattern sizes are wanted to substantiate this conclusion.

 

   References   Top

1. Pervez A, Zaman F, Aslam A, et al. Port catheter placement by nephrologists in an interventional nephrology coaching program. Semin Dial 2004;71:61-4.  Back to cited text no. 1    
2. Lund GB, Trerotola SO, Scheel PF Jr, et al. Final result of tunneled hemodialysis catheters positioned by radiologists. Radio­logy 1996;198:467-72.  Back to cited text no. 2  [PUBMED]  
3. Gibson SP, Mosquera D. 5 years expertise with the Quinton Permcath for vascular entry. Nephrol Dial Transplant 1991;6:269-74.  Back to cited text no. 3  [PUBMED]  
4. Schillinger F, Schillinger D, Montagnac R, et al. Put up catheterization vein stenosis in hemodialysis: comparative angiographic examine of fifty subclvian and 50 inside jugular entry. Nephrol Dial Transplant 1991;6:722-4.  Back to cited text no. 4  [PUBMED]  
5. Cimochowski GE, Worley E, Rutherford WE, et al. Superiority of the interior jugular over the subclavian entry for short-term hemodialysis. Nephron 1990;54:154-61.  Back to cited text no. 5  [PUBMED]  
6. Kanter RK, Zimmerman JJ, Strauss RH, et al. Central venous catheter insertion by femoral vein: security and effectiveness for pediatric affected person. Pediatrics 1986;77:842-7.  Back to cited text no. 6    
7. Lazarus HM, Creger RJ, Bloom AD, et al. Percutaneous placement of femoral central venous catheter in sufferers present process transplantation of bone marrow. Surg Gynecol Obstet 1990;170:403-6.  Back to cited text no. 7  [PUBMED]  
8. Rabitsch W, Kalhs P, Herold C, et al. Central venous catheter inserted percutaneously through the femoral vein can be utilized long run in recipients of allogenic peripheral blood stem cell transplants. Bone Marrow Transplant 1999;24:115-6.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9. Pearson ML. Guideline for prevention of intravascular-device-related an infection. Infect Management Hosp Epidemiol 1996;17:438-73.  Back to cited text no. 9  [PUBMED]  
10. Maki DG, Weise CE, Sarafin HW. A semiquantitative methodology for figuring out intravenous-catheter-related an infection. N Engl J Med 1977;296:1305-9.  Back to cited text no. 10  [PUBMED]  
11. Fan ST, Teoh-Chan CH, Lan KF, et al. Predictive worth of surveillance pores and skin and hub cultures in central venous catheters sepsis. J Hosp Infect 1988;12:191-8.  Back to cited text no. 11    
12. Linares J, Sitges-Serra A, Carau J, et al. Pathogenesis of catheter sepsis: a potential examine with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbiol 1985;21:357-60.  Back to cited text no. 12    
13. Sequra M, Uado L, Guiro X, et al. A potential examine for a brand new protocol for in situ prognosis of central venous catheter­associated bacteremia. Scientific Vitamin 1993;12:103-7.  Back to cited text no. 13    
14. Timsit JF, Sebille V, Farkas JC, et al. Results of subcutaneous tunneling on inside jugular catheter-related sepsis in critically unwell sufferers: a potential randomized multicenter examine. JAMA 1996;276:1416-20.  Back to cited text no. 14  [PUBMED]  
15. Timsit JF, Bruneel F, Cheval C, et al. Use of tunneled femoral catheters to stop catheter associated an infection: a randomized managed trial. Ann Intern Med 1999;130:729-35.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16. Decker MD, Edwards KM. Central venous catheter infections. Pediatr Clin North Am 1988;35:567-613.  Back to cited text no. 16  [PUBMED]  
17. Collignon P, Soni N, Pearson I, et al. Sepsis related to central vein catheter in critically unwell sufferers. Intensive Care Med 1988;14:227-31.  Back to cited text no. 17  [PUBMED]  
18. Oliver MJ, Gallery SM, Thorpe KE, et al. Threat of bacteremia from short-term hemodialysis catheters by web site of insertion and length of use: a potential examine. Kidney Int 2000;58:2543-5.  Back to cited text no. 18    
19. Goetz AM, Wagner MM, Miller JM, et al. Threat of an infection because of central venous catheters: impact of web site of place­ment and catheter sort. Infect Management Hosp Epidemiol 1998;19:842-5.  Back to cited text no. 19    
20. Murr MM, Rosenquist MD, Lewis RW II, et al. A potential security examine of femoral versus non-femoral vein catheterization in sufferers with burns. J Burn Care Rehabil 1991;12:576-8.  Back to cited text no. 20    
21. Mermel LA. Prevention of intravascular catheter-related an infection. Ann Intern Med 2000;132:391-402.  Back to cited text no. 21  [PUBMED]  [FULLTEXT]
22. Daniel T, Murai MD. Are femoral broviac catheters efficient and protected? A potential comparability of femoral and jugular boviac catheters in new child infants. Chest 2002;121:1527-30.  Back to cited text no. 22    
23. Pierco CM, Wade A, Moke Q, et al. Heparin-bonded central venous strains scale back thrombotic and infective problems in critically unwell kids. Intensive Care Med 2000;26:967-72.  Back to cited text no. 23    
24. Stillman RM, Soliman F, Garcia L, et al. Etiology of catheter related sepsis: correlation with thrombogenicity. Arch Surg 1977;112:1497-9.  Back to cited text no. 24  [PUBMED]  
25. Krafte-Jacobs B, Sivit CT, Mejia R, et al. Catheter-related thrombosis in critically unwell kids: comparability of catheters with and with out heparin bonding. J Pediatr 1995;126:50-4.  Back to cited text no. 25    
26. Marsh D, Wilkerson SA, Cook dinner LN, et al. Proper atrial thrombus formation screening utilizing two-dimensional echocardiograms in neonates with central venous catheters. Pediatrics 1988;81:284-6.  Back to cited text no. 26  [PUBMED]  
27. Mehta S, Connors Jr AF, Danish EH, et al. Incidence of thrombosis throughout central venous catheterization of newborns: a prospe­ctive examine. J Pediatr Surg 1992; 27:18-22.  Back to cited text no. 27    
28. Joynt GM, Kew J, Gomersall CD, et al. Deep venous thrombosis brought on by femoral venous catheters in critically unwell grownup sufferers. Chest 2000;117:178-83.  Back to cited text no. 28  [PUBMED]  [FULLTEXT]
29. Trerotola-Scot O. Hemodialysis catheter placement and administration. Radiology 2000;215:651-8.  Back to cited text no. 29    
30. Schwab SJ, Besarab A, Beathard G, et al. NKF-DOQI medical observe tips for vascular entry. Nationwide Kidney Founda­tion-Dialysis Final result High quality Initiative. Am J Kidney Dis 1997;30 (Suppl 3):S150-S91.  Back to cited text no. 30    


Top

Correspondence Deal with:
Abdulla Ok Al-Hwiesh
King Fahd Hospital of the College P.O. Field 40246, Al-Khobar, 31952
Saudi Arabia
Login to access the Email id

Crossref citations Examine

PMID: 17237889

Rights and Permissions

 
 

 
[Table – 1], [Table – 2]

Leave a Reply

Your email address will not be published. Required fields are marked *