title: Is guidewire exchange a better approach for subclavian vein re-catheterization for chronic hemodialysis patients?
abstract: BACKGROUND
  The objectives of this study were to compare outcomes and survival rates of subclavian vein re-catheterization through guide wire exchange (GWE) or de novo insertion (DN).
  
  
  METHODS
  The study was conducted in a retrospective manner. Medical records of 36 patients who received percutaneous subclavian vein re-catheterization for hemodialysis in our institution during the period from April 1, 2001 to September 30, 2004 were reviewed. All patients had at least 2 catheter insertions records in our institute. Incidences of adverse events (infection, thrombosis) were compared between GWE and DN groups using x2 test. Predictors for adverse event occurrences were analyzed using logistic regression models. Cox proportional hazard model was used to investigate the predictors for adverse event-free catheter days. Kaplan-Meire survival curves were computed and compared using log rank test.
  
  
  RESULTS
  Information were generated from 98 catheters (41 from DN, 57 from GWE groups). The average catheter usage was 2.8+/-0.9 devices per patient and the mean catheter-indwelling-day was 125.4+/-129.5 days in this cohort. We found GWE group had significantly lower thrombosis rate (49.1% vs. 85.4% for DN group, P<0.000) in general. Surgical approach was a significant risk factors for catheter thrombosis (GWE vs. DN, odds ratio=0.261, P=0.05). The actuarial survival rates for GWE were > or =30 days, 85.4%; > or =60 days, 75.5%; > or =90 days, 64.5%; > or =180 days, 44.3%. The actuarial survival rates for DN were > or =30 days, 70.7%; > or =60 days, 58.5%; > or =90 days, 34.2%; > or =180 days, 18.4%. GWE group catheters had significantly higher catheter survival rates (P=0.0009). Mahukar catheter (hazard ratio 0.514, P=0.03), non-shock (hazard ratio 3.358, P=0.04), and older age (hazard ratio 0.958, P=0.026) were predictors of adverse event-free remaining catheter days.
  
  
  CONCLUSIONS
  We suggest that GWE might be a favorable option over DN insertion when revised subclavian vein catheterization is inevitable. GWE can be performed repeatedly without compromising catheter outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Shaw-Min
authors.initials: SM
authors.lastname: Hou
authors.forename: Po-Ching
authors.initials: PC
authors.lastname: Chou
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Huang
authors.forename: Chih-Hui
authors.initials: CH
authors.lastname: Chin
authors.forename: Pa-Chun
authors.initials: PC
authors.lastname: Wang
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome