Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: A randomized controlled study
- 1 April 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 38 (4), 1118-1125
- https://doi.org/10.1097/ccm.0b013e3181d454b3
Abstract
To compare dialysis catheter function according to catheter site. Multicenter, open, randomized controlled trial. Nine university-affiliated hospitals and three general hospitals in France. Seven hundred thirty-six patients in intensive care units who required a first venous catheterization to perform either intermittent hemodialysis (470 patients with 1275 sessions) or continuous renal replacement therapy (266 patients with 1003 days). Patients randomly received either femoral (n = 370) or jugular (n = 366) catheterization. For the jugular site, right-side position (n = 252) was recommended. Time to catheter ablation for dysfunction, urea reduction ratio (intermittent hemodialysis), and downtime (continuous renal replacement therapy) were assessed for all participants and evaluated by randomly assigned catheterization site (femoral or jugular). Baseline demography and dialysis prescriptions were similar between the site arms. In modified intent-to-treat, catheter dysfunction occurred in 36 of 348 (10.3%) and 38 of 342 (11.1%) patients in the femoral and jugular groups, respectively. The risk of catheter dysfunction did not significantly differ between randomized groups (hazard ratio, 1.06; 95% confidence interval, 0.67-1.68; p = .80). Compared to the femoral site, the observed risk of dysfunction decreased in the right jugular position (15 of 226; 6.6%; adjusted hazard ratio, 0.58; 95% confidence interval, 0.31-1.07; p = .09) and significantly increased in the left jugular position (23 of 118; 19.5%; adjusted hazard ratio, 1.89; 95% confidence interval, 1.12-3.21; p < .02). The postintermittent hemodialysis mean urea reduction ratio per session was 50.8% (standard deviation, 16.1) for femoral vs. 52.8% (standard deviation, 15.8) for jugular (p = .30) sites, and the median continuous renal replacement therapy downtime per patient-day was 1.17 hrs (interquartile range, 0.75-1.50) for both sites (p = .98). In terms of catheter dysfunction and dialysis performance among critically ill adults requiring acute renal replacement therapy, jugular site did not significantly outperform femoral site placement.Keywords
This publication has 33 references indexed in Scilit:
- Femoral vs Jugular Venous Catheterization and Risk of Nosocomial Events in Adults Requiring Acute Renal Replacement TherapyJama-Journal Of The American Medical Association, 2008
- Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its MalfunctionAmerican Journal of Nephrology, 2007
- Vascular Access for HD and CRRT40 Years Of Continuous Renal Replacement Therapy, 2007
- Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control studyCritical Care, 2006
- Factors Associated With Urea Reduction Ratio in Acute Renal FailureArtificial Organs, 2004
- Temporary Vascular Catheters for Hemodialysis: A 3-Year Prospective StudyThe International Journal of Artificial Organs, 2004
- Alcoholic povidone-iodine to prevent central venous catheter colonization: A randomized unit-crossover study*Critical Care Medicine, 2004
- Risk Factors of Nontunneled Noncuffed Hemodialysis Catheter MalfunctionNephron Clinical Practice, 2004
- Vascular Access for Extracorporeal Renal Replacement Therapy in the Intensive Care UnitContributions to nephrology, 2004
- Access recirculation in temporary hemodialysis catheters as measured by the saline dilution techniqueAmerican Journal of Kidney Diseases, 2000