Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

Kirsteen Burton, Jeremy O'Brien, Dheeraj Rajan

McGill University, Montreal, Canada.
University of Toronto, Toronto, Canada.

DOI: 10.4236/ojrad.2012.23011                

Abstract

Purpose: To determine whether radiographic heart morphology and echocardiography findings were associated with early central venous catheter (CVC) failure in hemodialysis patients. Materials & Methods: All hemodialysis catheter insertions between 1996-2007 were captured in a combined nephrology radiology database. Factors were identified that may be associated with early catheter failure. Factors examined included: echocardiography findings, radiographic evidence of flattened heart border, boot-shaped heart and left ventricular hypertrophy as well as patient comorbidities and peri-procedural characteristics. Results: Of the 132 CVC failures in 132 patients, 67 (50.8%) occurred within 30 days of insertion. Early CVC failure was more likely to occur in patients who had insertions from the left side (?2, p = 0.020) and with catheter tip position outside the cavoatrial junction (?2, p = 0.040). CVC failure rates also differed by year of placement (?2, p < 0.01), if the patient had evidence of left ventricular hypertrophy (?2, p = 0.030), left systolic dysfunction (?2, p = 0.030), and hypokinetic right wall mechanics (?2, p < 0.01). Conclusion: Radiographic findings of left ventricular hypertrophy and echocardiography findings of left systolic dysfunction were found to be associated with early failure.

Keywords

Dialysis; Interventional Radiology; Echocardiography

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. Astor, J. Eustace, N. Powe, et al., “Type of Vascular Access and Survival among Incident Hemodialysis Patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study,” Journal of the American Society of Nephrology, Vol. 16, No. 5, 2005, pp. 1449-1455. doi:10.1681/ASN.2004090748
[2]	F. Quarello, G. Forneris, M. Borca, et al., “Do Central Venous Catheters have Advantages over Arteriovenous Fistulas or Grafts?” Journal of Nephrology, Vol. 19, No. 3, 2006, pp. 265-279.
[3]	D. Mendelssohn, J. Ethier, S. Elder, et al., “Haemodialysis Vascular Access Problems in Canada: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II),” Nephrology Dialysis Transplant, Vol. 21, No. 3, 2006, pp. 721-728. doi:10.1093/ndt/gfi281
[4]	D. Chand, B. Teo, R. Fatica, et al., “Influence of Vascular Access Type on Outcome Measures in Patients on Maintenance Hemodialysis,” Nephron Clinical Practice, Vol. 108, No. 2, 2008, pp. 91-98. doi:10.1159/000113525
[5]	A. Freeman, M. Gallagher, A. Gray-Weale, et al., “Surgical Practice to Reduce Dialysis Access Insufficiency,” ANZ Journal of Surgery, Vol. 78, No. 5, 2008, pp. 377382. doi:10.1111/j.1445-2197.2008.04481.x
[6]	A. Falk, “Use of the Femoral Vein as Insertion Site for Tunneled Hemodialysis Catheters,” Journal of Vascular and Interventional Radiology, Vol. 18, No. 2, 2007, pp. 217-225. doi:10.1016/j.jvir.2006.12.001
[7]	B. Canaud, L. Chenine, D. Henriet, et al., “Optimal Management of Central Venous Catheters for Hemodialysis,” Contributions to Nephrology, Vol. 161, 2008, pp. 39-47. doi:10.1159/000129752
[8]	O. Lee, J. Raque, L. Lee, et al., “Retrospective Assessment of Risk Factors to Predict Tunneled Hemodialysis Catheter Outcome,” Journal of Vascular and Interventional Radiology, Vol. 15, No. 5, 2004, pp. 457-461. doi:10.1097/01.RVI.0000124942.24134.62
[9]	B. Peynircioglu, F. Ozkan, M. Canyigit, et al., “Tunneled Internal Jugular Catheters in Adult Patients: Comparison of Outcomes in Hemodialysis versus Infusion Catheters,” Acta Radiologica, Vol. 48, No. 6, 2007, pp. 613-619. doi:10.1080/02841850701342104
[10]	T. Wilkin, M. Kraus, K. Lane, et al., “Internal Jugular Vein Thrombosis Associated with Hemodialysis Catheters,” Radiology, Vol. 228, No. 3, 2003, pp. 697-700. doi:10.1148/radiol.2283020681
[11]	A. Bakken, C. Protack, W. Saad, et al., “Long-Term Outcomes of Primary Angioplasty and Primary Stenting of Central Venous Stenosis in Hemodialysis Patients,” Journal of Vascular Surgery, Vol. 45, No. 4, 2007, pp. 776783. doi:10.1016/j.jvs.2006.12.046
[12]	A. Falk and S. Parthasarathy, “Conversion of Temporary Hemodialysis Catheters to Tunneled Hemodialysis Catheters,” Clinical Nephrology, Vol. 63, No. 3, 2005, pp. 209214.
[13]	M. Napoli, A. Montinaro, F. Russo, et al., “Ultrasound Guided Brachial Arterial Angioplasty during the Creation of a Radio-Cephalic Arteriovenous Fistula: A Case Report,” Journal of Vascular Access, Vol. 7, No. 1, 2006, pp. 38-42.
[14]	J. E. Silberzweig, D. Sacks, A. S. Khorsandi, et al., “Reporting Standards for Central Venous Access,” Journal of Vascular and Interventional Radiology, Vol. 14, No. 9, 2003, pp. 443-452. doi:10.1097/01.RVI.0000094617.61428.bc
[15]	M. Mahlon and H. Yoon, “CT Angiography of the Superior Vena Cava: Normative Values and Implications for Central Venous Catheter Position,” Journal of Vascular and Interventional Radiology, Vol. 18, No. 9, 2007, pp. 1106-1110. doi:10.1016/j.jvir.2007.06.002
[16]	K. Albrecht, H. Nave, D. Breitmeier, et al., “Applied Anatomy of the Superior Vena Cava—The Carina as a Landmark to Guide Central Venous Catheter Placement,” British Journal of Anaesthesia, Vol. 92, No. 1, 2004, pp. 75-77. doi:10.1093/bja/aeh013
[17]	L. Oguzkurt, F. Tercan, D. Torun, et al., “Impact of Short-Term Hemodialysis Catheters on the Central Veins: a Catheter Venographic Study,” European Journal of Radiology, Vol. 52, No. 3, 2004, pp. 293-299. doi:10.1016/j.ejrad.2003.12.004
[18]	T. Vesely, “Central Venous Catheter Tip Position: A Continuing Controversy,” Journal of Vascular and Interventional Radiology, Vol. 14, No. 5, 2003, pp. 527-534. doi:10.1097/01.RVI.0000071097.76348.72
[19]	G. Abood, K. Davis, T. Esposito, et al., “Comparison of Routine Chest Radiograph versus Clinician Judgment to Determine Adequate Central Line Placement in Critically Ill Patients,” Journal of Trauma, Vol. 63, No. 1, 2007, pp. 50-56. doi:10.1097/TA.0b013e31806bf1a3
[20]	J. Boon, A. van Schoor, P. Abrahams, et al., “Central Venous Catheterization—An Anatomical Review of a Clinical Skill—Part 1: Subclavian Vein via the Infraclavicular Approach,” Clinical Anatomy, Vol. 20, No. 6, 2007, pp. 602-611. doi:10.1002/ca.20486
[21]	L. Eisen, M. Narasimhan, J. Berger, et al., “Mechanical Complications of Central Venous Catheters,” Journal of Intensive Care Medicine, Vol. 21, No. 1, 2006, pp. 40-46. doi:10.1177/0885066605280884
[22]	R. Botha, A. van Schoor, J. Boon, et al., “Anatomical Considerations of the Anterior Approach for Central Venous Catheter Placement,” Clinical Anatomy, Vol. 19, No. 2, 2006, pp. 101-105. doi:10.1002/ca.20240
[23]	A. Pikwer, L. Baath, B. Davidson, et al., “The incidence and Risk of Central Venous Catheter Malpositioning: A Prospective Cohort Study in 1619 Patients,” Anaesthesia and Intensive Care, Vol. 36, No. 1, 2008, pp. 30-37.
[24]	H. Hamilton and D. Foxcroft, “Central Venous Access Sites for the Prevention of Venous Thrombosis, Stenosis and Infection in Patients Requiring Long-Term Intravenous Therapy,” Cochrane Database Systematic Review, Vol. 3, 2007.
[25]	C. Male, P. Chait, M. Andrew, et al., “Central Venous Line-Related Thrombosis in Children: Association with Central Venous Line Location and Insertion Technique,” Blood, Vol. 101, No. 11, 2003, pp. 4273-4278. doi:10.1182/blood-2002-09-2731
[26]	D. Xiang, E. Verbeken, A. Van Lommel, et al., “Composition and formation of the sleeve enveloping a central venous catheter,” Journal of Vascular Surgery, Vol. 28, No. 2, 1998, pp. 260-271. doi:10.1016/S0741-5214(98)70162-4
[27]	S. Ford and P. Manley, “Indwelling Cardiac Catheters: An Autopsy Study of Associated Endocardial Lesions,” Archives of Pathology and Laboratory Medicine, Vol. 106, No. 7, 1982, pp. 314-317.
[28]	N. K. Foundation, “K/DOQI Clinical Practice Guidelines for Vascular Access,” American Journal of Kidney Disease, Vol. 37, No. 1, 2001, pp. S137-S181. doi:10.1016/S0272-6386(01)70007-8
[29]	V. Puel, M. Caudry and P. Le Metayer, “Tunneled Catheter Associated Atrial Thrombi: Successful Treatment with Chronic Anticoagulation,” Hemodialysis International, Vol. 5, 1993, pp. 32-36.
[30]	A. Cadman, J. A. Lawrance, L. Fitzsimmons, et al., “To Clot or Not to Clot? That is the Question in Central Venous Catheters,” Clinical Radiology, Vol. 59, No. 4, 2004, pp. 349-355.
[31]	E. J. Kingdon, S. G. Holt, J. Davar, et al., “Atrial Thrombus and Central Venous Dialysis Catheters,” American Journal of Kidney Diseases, Vol. 38, No. 3, 2001, pp. 631-639.