Original InvestigationDialysisA Randomized Trial of Catheters of Different Lengths to Achieve Right Atrium Versus Superior Vena Cava Placement for Continuous Renal Replacement Therapy
Section snippets
Study Design
This was a single-center, unblinded, randomized, controlled trial with parallel-group design and 1:1 allocation ratio.
Setting & Participants
This study was conducted in a 31-bed multidisciplinary intensive care unit (ICU) in which CRRT is the only form of acute dialysis used. After obtaining Hospital Ethics Committee approval, this study was granted a waiver for patients unable to provide written consent at the time of enrolment. An interim analysis of safety data after the first 40 participants was presented to our
Recruitment
Of 100 patients eligible and enrolled in the study between February 2010 and February 2011, a total of 50 patients was randomly assigned to each of the 2 short-term dialysis catheter groups (shorter vs longer catheters). Six patients could not complete the study (Fig 2), but 5 of these patients who were randomly assigned still had a catheter inserted and were followed up for any possible complications attributable to their catheter position per intention-to-treat analysis.
Baseline Characteristics
Baseline
Discussion
The optimal position for the tip of a dialysis catheter in the delivery of renal replacement therapy remains uncertain and controversial. The Society of Interventional Radiology Technology Assessment Committee in 2003 published the “Reporting Standards for Central Venous Access,” suggesting that the best location for the CVC tip has not yet been determined.7 The National Kidney Foundation KDOQI (Kidney Disease Outcomes Quality Initiative) 2006 guidelines stated that short-term dialysis catheter
Acknowledgements
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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Cited by (62)
Feasibility Analysis of Ultrasound-Guided Placement of Tunneled Hemodialysis Catheters
2023, Kidney International ReportsManagement of Acute Kidney Injury/Renal Replacement Therapy in the Intensive Care Unit
2022, Surgical Clinics of North AmericaContinuous Renal Replacement Therapies for Acute Kidney Injury
2022, Handbook of Dialysis TherapyDeeper may not be better: relationship between catheter dysfunction and location of the catheter tip in right-sided tunnelled haemodialysis catheters
2022, Clinical RadiologyCitation Excerpt :Another hypothesis on how CVC tip location relates to catheter dysfunction suggests that contact between the catheter tip and the SVC or atrial wall negatively impacts fluid dynamics and promotes fibrin sheath formation.26 This has led some authors to recommend placing the CVC tip in the right atrium due to the theoretical possibility of the SVC wall collapsing against the catheter during haemodialysis.27 Based on the results of the present study, the higher occurrence of catheter dysfunction amongst step-tip CVCs ending deep in the right atrium may similarly be related to abutment against the atrial wall.
Management of Acute Kidney Injury in Coronavirus Disease 2019
2020, Advances in Chronic Kidney DiseaseCitation Excerpt :The femoral vein site may be associated with higher risk for infections and blood flows may be affected in patients who need to be proned for ventilation. The left IJ can provide inadequate blood flow, especially when shorter catheters are inadvertently placed.33 In the setting of a surge, physicians not familiar with hemodialysis catheters may be responsible for placing catheters in patients with COVID-19.
Originally published online on April 13, 2012.
Trial registration: www.ANZCTR.org.au; study number: ACTRN12611000759998.