Prevalence and risk factors of central venous stenosis among hemodialysis patients

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#IVTEAM #Intravenous literature: “CVS is highly prevalent among studied HD patients, particularly in the presence of suggestive clinical signs. The number of HD catheter placements and subclavian vein utilization for dialysis access impose a significantly higher risk of CVS. ” Osman et al (2014).

Reference:

Osman, O.O., El-Magzoub, A.R. and Elamin, S. (2014) Prevalence and Risk Factors of Central Venous Stenosis among Prevalent Hemodialysis Patients, a Single Center Experience. Arab Journal of Nephrology and Transplantation. 7(1), p.45-7.

Abstract:

Introduction: Central vein stenosis (CVS) is a common complication of central venous catheter (CVC) insertion. In this study we evaluated the prevalence and risk factors of CVS among hemodialysis (HD) patients in a single center in Sudan, using Doppler ultrasound as a screening tool.

Methods: The study included 106 prevalent HD patients. For every patient, we performed Duplex Doppler for the right and left jugular, subclavian and femoral veins. A patient was considered to have hemodynamically significant stenosis if the pre-stenosis to the post-stenosis velocities ratio was ≥ 2.5 or they had complete vein occlusion.

Results: Overall, 28.3% of patients had Doppler detected CVS, including 25.5% with hemodynamically significant stenosis and 2.8% with compromised flow. The prevalence of CVS was 68.4% among symptomatic patients compared to 19.5% in asymptomatic patients. The prevalence of CVS among patients with history of 0-1, 2-3 and ≥4 central venous catheters was 3.4%, 29.4% and 53.8% respectively (p=0.00). CVS was not more common in patients with history of previous/current jugular or femoral vein catheterization compared to no catheter placement in these veins (28.3% vs 28.6% and 35% vs 26.7% respectively; p >0.1). However, CVS was significantly more common in patients with previous/ current subclavian vein catheterization compared to no catheter placement in this vein (47.8% vs 22.9%, p = 0.02).

Conclusion: CVS is highly prevalent among studied HD patients, particularly in the presence of suggestive clinical signs. The number of HD catheter placements and subclavian vein utilization for dialysis access impose a significantly higher risk of CVS.

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