title: Hemodialysis catheters with citrate locking in critically ill patients with acute kidney injury treated with intermittent online hemofiltration or hemodialysis.
abstract: The purpose of the study was to compare the long-term catheter-related complications associated with temporary untunneled hemodialysis catheters, locked with citrate in the interdialysis period, inserted in critically ill patients with acute kidney injury, between different catheter insertion sites (femoral vs. jugular and subclavian) and catheter types (single-lumen [SL] vs. double-lumen [DL]). In a retrospective clinical study, the long-term catheter-related complications in 290 critically ill patients treated with intermittent high-volume online hemofiltration or hemodialysis between December 2004 and January 2008 were analyzed. Among 534 inserted catheters, 493 (92.3%) were femoral, 29 (5.4%) jugular, and 12 (2.3%) subclavian; 304 (56.9%) were SL and 230 (43.1%) were DL. There were 125 (20.3/1000 catheter days [c.d.]) thrombotic complications, while infectious complications were exceptionally rare, that is, only 13 (2.1/1000 c.d.), of which 10 (1.6/1000 c.d.) were possible catheter-related bloodstream infections and 3 (0.5/1000 c.d.) exit-site infections. The incidence rate of all thrombotic complications was significantly lower in all jugular and subclavian vs. all femoral catheters (7.7/1000 c.d. vs. 21.8/1000 c.d., P = 0.01), and in all SL vs. DL catheters (11.4/1000 c.d. vs. 32.2/1000 c.d., P < 0.001). The incidence rate of any possible catheter-related bloodstream and exit-site infections was not significantly different in all jugular and subclavian vs. all femoral catheters, neither in femoral SL vs. DL catheters. The major long-term catheter-related complications were thrombotic, and significantly more frequent in DL vs. SL catheters. Infectious complications were exceptionally rare, most probably due to the strict catheter care protocol, as well as the routine use of a citrate catheter lock and antibiotic ointment at the catheter exit-site.
authors.affiliation: Department of Nephrology, University Medical Center Ljubljana, SI-1000 Ljubljana, Slovenia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Skofic
authors.forename: Jadranka
authors.initials: J
authors.lastname: Buturović-Ponikvar
authors.forename: Janko
authors.initials: J
authors.lastname: Kovac
authors.forename: Vladimir
authors.initials: V
authors.lastname: Premru
authors.forename: Bojan
authors.initials: B
authors.lastname: Knap
authors.forename: Andreja
authors.initials: A
authors.lastname: Marn Pernat
authors.forename: Bostjan
authors.initials: B
authors.lastname: Kersnic
authors.forename: Jakob
authors.initials: J
authors.lastname: Gubensek
authors.forename: Rafael
authors.initials: R
authors.lastname: Ponikvar
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002951:Citrates / Q000008:administration & dosage; D016638:Critical Illness; D005260:Female; D005268:Femoral Vein; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013350:Subclavian Vein; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D002951:Citrates; C514290:trisodium citrate