Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study.
OBJECTIVE
To compare dialysis catheter function according to catheter site.


METHODS
Multicenter, open, randomized controlled trial.


METHODS
Nine university-affiliated hospitals and three general hospitals in France.


METHODS
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).


METHODS
Patients randomly received either femoral (n = 370) or jugular (n = 366) catheterization. For the jugular site, right-side position (n = 252) was recommended.


RESULTS
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).


CONCLUSIONS
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.
Parienti
Jean-Jacques
JJ
Department of Biostatistics and Clinical Research, Côte de Nacre University Hospital Center, Caen, France. parienti-jj@chu-caen.fr
Mégarbane
Bruno
B
Fischer
Marc-Olivier
MO
Lautrette
Alexandre
A
Gazui
Nicole
N
Marin
Nathalie
N
Hanouz
Jean-Luc
JL
Ramakers
Michel
M
Daubin
Cédric
C
Mira
Jean-Paul
JP
Charbonneau
Pierre
P
du Cheyron
Damien
D
D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007601:Jugular Veins; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods*; D013997:Time Factors