Document Detail


Catheter management in hemodialysis patients: delivering adequate flow.
MedLine Citation:
PMID:  21115628     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Over 330,000 individuals in the United States depend on hemodialysis (HD), the majority as a result of end-stage renal disease. Sustainable vascular access can be achieved through arteriovenous fistulas, arteriovenous grafts, or tunneled catheters. Tunneled dialysis catheters (TDCs) often remain in use for months or even years, long beyond their initial intended use as a bridging device. Research efforts are focused on identifying strategies to prevent/minimize the risk of the most common catheter-related complications: thrombotic occlusion and infection. Thrombotic occlusion of TDCs prevents adequate dialysis but can be managed successfully through thrombolytic agents to restore/improve blood flow in the majority of patients, allowing immediate HD delivery and prolonging usability of the TDC. Occasionally, catheter exchange with fibrin sheath disruption is needed to preserve the site. Surface-treated catheters could improve the morbidity and mortality associated with HD delivery via an indwelling catheter, but results from studies have been disappointing to date. We review the etiology of catheter-based access failure and the monitoring and interventional steps that should be taken to maintain the patency and safety of catheters for HD. Wherever possible we note the areas in which there is scant data where further randomized clinical trials are needed.
Authors:
Anatole Besarab; Rahul Pandey
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Publication Detail:
Type:  Journal Article     Date:  2010-11-29
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  6     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  227-34     Citation Subset:  IM    
Affiliation:
Division of Nephrology and Hypertension, Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202. abesara1@hfhs.org.
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