Chapter 177 - Hemodialysis access dialysis catheters Flashcards

1
Q

Length of time an acute catheter can be left in

A

< 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Length of time a chronic tunneled catheter can be left in

A

12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indications for catheter insertion

A

1) urgent HD while waiting for AVF maturation
2) non-anatomical feasible AVF or not surgical candidate
3) temporary alternative access to avoid usual access complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Benefit of catheter insertion over other methods

A

1) Immediate use
2) uncomplicated needle-free access
3) avoid cannulation site complications
4) ease of use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment goals of catheterization

A

1) high rate 300-340 ml/min

2) avoid recirculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Arterial lumen and venous lumen definition

A
Arterial = patient to HD machine
Venous = HD machine to patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Designs of catheters

A

1) split tip
2) step tip
3) dual catheter
4) tal palindrome symmetrical tip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Benefit of each different designs of catheters

A

no difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pre-operative considerations

A

1) prior line, avf, avg
2) prior infection
3) pacemaker history
4) coagulation disorders
5) PEX: scars, edema, venous collaterals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pre-op imaging problems with each modality

A

US: hard to see central veins
MRI: gadolinium induced nephrogenic systemic fibrosis
CTV: high volume contrast
Catheter based venogram: gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patency based on location

A

Right IJ > Left IJ > femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Subclavian line downfall

A

worsen future AVF if fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

optimal Location of cuff

A

1 cm proximal to exit site on skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

optimal Location of tip

A

caval-atrial junction at shadow of right main bronchus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Filling of line to prime options

A

1) citrate sodium

2) low dose heparin < 5000 Units/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Unconventional catheter sites

A

1) translumbar: prone, direct to IVC

2) transhepatic: to right or mid hepatic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Problems with unconventional catheters

A

1) infection
2) migration
3) thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Central line complication rates overall

A

7.1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Complications of central dialysis line

A

1) pneumothorax
2) hemothorax
3) wire embolism
4) arrhythmia
5) cardiac perforation
6) thoracic duct lasceration
7) nerve injury
8) catheter misplacement
9) air embolism
10) catheter fracture and embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment for pneumothorax

A

1) watchful waiting
2) thoracostomy
3) needle decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Reason to treat catheter related pneumothorax

A

1) tension pneumothorax
2) symptomatic
3) > 20% pneumothorax

22
Q

Reasons why hemothorax are hard to treat

A

1) negative pressure of chest

2) lack of tamponade

23
Q

Treatment for wire or catheter embolism

A

Snare

24
Q

Complication rate of arrhythmia needing cardioversion

A

< 1%

25
Q

Cardiac perforation signs

A

All related to tamponade

1) muffled heart sounds
2) tachycardia
3) large globular cardiac silhouette

26
Q

Thoracic duct laceration treatment

A

1) remove catheter

2) pressure

27
Q

Nerve injury

A

1) Brachial plexus
2) vagus/recurrent laryngeal –> horseness
3) phrenic –> raised hemidiaphragm
4) sympathetic (stellate ganglion) –> horner

28
Q

Catheter misplacement rate

A

3.3%

29
Q

Problem with catheter misplacement in venous system

A

Intimal damage –> thrombosis or erosion

30
Q

Management of carotid catheter placement

A

pressure if <4 hours otherwise explore

31
Q

Treatment of air embolism

A

1) cap the line
2) Durant maneuvre: trendelenburg and left lateral decubitus
3) aspirate air in heart using line

32
Q

Catheter occlusion rate

A

30-40%

33
Q

Cause of catheter occlusion

A

Development of fibrin plug/sleeve at tip

34
Q

Can infuse but cannot withdraw from a line

A

sign of impending failure

35
Q

Evidence on preventing catheter occlusion

A

no evidence all lock solution same

antiplatelet and anticoag too risky

36
Q

Treatment of catheter occlusion

A

1) alteplace
2) snare fibrin sheath
3) balloon fracture
4) replace sheath

37
Q

Alteplace dose for clearing line

A

2 mg dwell 2-3 hours

77% success one time, 10% addition success second time

38
Q

Central venous thrombosis rate

A

30% of patients with CVC

only 50% are clinically significant

39
Q

PE from CVC thrombosis rate

A

0-17%

associated with infections

40
Q

signs/symptoms of CVC thrombosis

A

1) edema/swelling
2) prominent collateral veins
3) emboli
4) fever

41
Q

Treatment of CVC thrombosis

A

1) anticoagulation

2) catheter removal

42
Q

Central venous stenosis rate of subclavian vs IJ

A

42% vs 10%

43
Q

Treatment of central venous stenosis

A

1) elevation and compression

2) PTA +/- stent +/- DCB

44
Q

CVC infection classifications (Tunneled lines)

A

1) exit site: distal to cuff
2) tunneled infection: superior to cuff
3) catheter related bacteremia

45
Q

Incidence of catheter related bacteremia

A

0.6-6.5/1000 catheter days

46
Q

Usual organism of catheter related infections

A

Gram + 52-84%

S. aureus 21-45%

47
Q

Treatment of catheter infection

A

1) remove

2) antibiotics

48
Q

Antibiotic duration for catheter infection for Gram +, Gram - and fungi

A

Gram + 4-6 weeks (S aureus mostly)
Gram - 1-2 weeks
Fungi 2 weeks

49
Q

KDOQI criteria for stopping antibiotics

A

Wait 48hours after culture negative then stop antibiotics

50
Q

Catheter salveage failure rate after infection

A

> 65%