To analyze the practice pattern of vascular access use and complication rates in patients receiving continuous renal replacement therapy from a large Chinese urban medical center” Ten et al (2019).
Abstract:
OBJECTIVE: To analyze the practice pattern of vascular access use and complication rates in patients receiving continuous renal replacement therapy from a large Chinese urban medical center.
METHODS: Patients who had received CRRT from April to October, 2014 in our center were included in this study. Demographic data, primary disease, department for hospitalization, blood pressure, heart rate, SOFA score, APACHE II score, presence of mechanical ventilation, CRRT modalities, choice of functioning vascular access, site and duration of catheter insertion, presence of recatheterization, cumulative catheter indwelling time, catheter malfunction and catheter-related infections, as well as laboratory test results, were collected.
RESULTS: A total of 292 patients were enrolled in our study, including 175 males (59.9%) and 117 females (40.1%), aged 50.8±18.6 years (range, 12 to 94 years). Patients who needed CRRT were mainly caused by acute kidney injury, multiple organ dysfunction syndrome and systemic inflammatory response syndrome. Initial vascular access was non-cuffed temporary catheters in 280 patients and it was preferentially obtained in the right internal jugular vein (54.3%). There were 32 (11.4%) patients needed re-catheterization. Catheter malfunction accounted for 7.14% of all patients, and the median time of catheter malfunction was found at the 5th day. By multivariate analysis，it was found that the main risk factors of catheter malfunction were cumulative treatment time of CRRT and the level of hemoglobin. The average time of catheter related infections was 10.7 days after insertion and the catheter-related infections were 7.19 per 1000 catheter days. The main risk factors of catheter-related infections were cumulative time of catheterization and the level of serum albumin.
CONCLUSION: In this cohort of critically ill patients, the main risk factors for catheter malfunction were cumulative CRRT time and the level of hemoglobin. In addition，the main risk factors of catheter-related infections were cumulative time of catheterization and the level of serum albumin.
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Reference:
Ren, H., Ge, Y., He, X., Li, C., Xu, B., Gong, D. and Liu, Z. (2019) Vascular access in patients treated with continuous renal replacement therapy: a report from a single center in China. Therapeutic Apheresis and Dialysis. March 7th. [epub ahead of print].
doi: 10.1111/1744-9987.12799.