TY - JOUR
T1 - Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population
T2 - A quality improvement initiative
AU - Bhutani, Gauri
AU - El Ters, Mireille
AU - Kremers, Walter K.
AU - Klunder, Joe L.
AU - Taler, Sandra J.
AU - Williams, Amy W.
AU - Stockland, Andrew H.
AU - Hogan, Marie C.
N1 - Funding Information:
Research idea and study design: GB, MET, and MCH; data acquisition: GB, JLK; data analysis/interpretation: GB, MH, WK; statistical analysis: GB; supervision or mentorship: MCH, AS, AWW, and SJT. Each author contributed to the manuscript writing, revisions, and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. GB takes responsibilities that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. We acknowledge contributions by Ms. Wilson and Ms. Mahon that enabled us to identify the current magnitude of PICC use and AVF prevalence rates at our center. PICC volumes at Mayo Clinic, Rochester were provided to us by Amy Mahon, MHA, RN. We received data regarding the Mayo Clinic, Rochester dialysis units? fistula rates from Ms. Jerilyn Wilson (System Process Analyst, Mayo Clinic Dialysis Services).
Publisher Copyright:
© 2016 International Society for Hemodialysis
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Introduction: Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs, was evaluated. Methods: A retrospective observational study, involving individuals ≥18 years of age who underwent TSB-CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings: The study cohort included 92 patients with a median age of 55 (46–67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11–43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion: TSB-CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.
AB - Introduction: Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs, was evaluated. Methods: A retrospective observational study, involving individuals ≥18 years of age who underwent TSB-CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings: The study cohort included 92 patients with a median age of 55 (46–67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11–43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion: TSB-CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.
KW - Chronic kidney disease
KW - end stage renal disease
KW - peripherally inserted central catheter venous
KW - thrombosis
KW - tunneled central venous catheters
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U2 - 10.1111/hdi.12484
DO - 10.1111/hdi.12484
M3 - Article
C2 - 27647824
AN - SCOPUS:85016586462
VL - 21
SP - 284
EP - 293
JO - Hemodialysis International
JF - Hemodialysis International
SN - 1492-7535
IS - 2
ER -