CJASN
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published ahead of print on October 17, 2007
Clin J Am Soc Nephrol 2: 1201-1206, 2007
© 2007 American Society of Nephrology
doi: 10.2215/CJN.01910507
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
CJN.01910507v1
2/6/1201    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Oliver, M. J.
Right arrow Articles by Lok, C. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Oliver, M. J.
Right arrow Articles by Lok, C. E.

Dialysis

Catheter Patency and Function after Catheter Sheath Disruption: A Pilot Study

Matthew J. Oliver*, David C. Mendelssohn{dagger}, Robert R. Quinn*, Elizabeth P. Richardson*, Deeraj K. Rajan{ddagger}, Robyn A. Pugash*, Joyce A. Hiller*, Alex J. Kiss*, and Charmaine E. Lok{ddagger}

* Sunnybrook Health Sciences Centre, {dagger} Humber River Regional Hospital, and {ddagger} University Health Network, Toronto, Ontario, Canada

Correspondence: Dr. Matthew James Oliver, Sunnybrook Health Sciences Centre, Room A239, 2075 Bayview Avenue, Toronto, Canada M4N 3M5. Phone: 416-480-4755; Fax: 416-480-4245; E-mail: matthew.oliver{at}sunnybrook.ca

Background and objectives: Hemodialysis catheters are frequently complicated by dysfunction from fibrin sheaths. Previous studies of sheath disruption have methodologic limitations but suggest that the patency after disruption is short.

Design, setting, participants, & measurements: A randomized, controlled, pilot trial was conducted to investigate the impact of angioplasty sheath disruption on catheter patency and function. Forty-seven long-term hemodialysis patients with secondary, refractory catheter dysfunction underwent guidewire exchange to replace their catheters.

Results: Sheaths were present in 33 (70%) of the 47 patients. In 18 patients who were randomly assigned to disruption, the median time to repeat dysfunction was 373 d compared with 97.5 d in patients who did not undergo disruption (P = 0.22), and the median time to repeat catheter exchange was 411 and 198 d, respectively (P = 0.17). Mean blood flow (340 versus 329 ml/min; P < 0.001) and urea reduction ratio (72 versus 66%; P < 0.001) were higher in the disruption group. Fourteen patients had no sheaths, and their median times to repeat dysfunction and repeat exchange were 849 and 879 d, respectively. Patients with no sheaths had higher urea reduction ratio (73 versus 66%; P < 0.001) and a lower percentage of inadequate hemodialysis treatments (9.8 versus 27%; P = 0.01) and treatments that required thrombolytics (1.8 versus 5.0%; P = 0.03) than patients with sheaths that were not disrupted.

Conclusions: Disrupting sheaths by angioplasty balloon results in durable catheter patency and modestly improves blood flow and clearance over the duration of catheter use.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the American Society of Nephrology.