Bruna Brunetta Gavranić

Complications of Permanent Hemodialysis Catheter Placement; Need for Better Pre-Implantation Algorithm?

There is a correlation between central venous cannulation and the development of central venous stenosis. Minor retrosternal vein lesions can be easily missed. Computerized tomographic (CT) venography is the diagnostic procedure of choice. The aim of this study was to examine the complications after catheter implantation in patients with prior permanent catheter placement and to evaluate present diagnostic procedures performed prior to choosing permanent access site in order to reduce possible complications after catheter placement. Complications of permanent CVC insertion in our department were analyzed between October 2011 and February 2015. We have implanted the Tesio twin catheter system and the Hickman Bard dual lumen catheter. All patients with prior permanent dialysis catheter were evaluated with color doppler, while patients with suspected central venous stenosis (CVS) or thrombosis were evaluated with phlebography or CT venography prior to catheter placement. One hundred and ninety‐eight permanent dialysis catheters were placed (173 Tesio [87.4%] and 25 Hickman [12.6%]) in 163 patients. There were 125 patients (76.7%) with prior temporary catheter and 61 (48.8%) of them had more than one prior permanent catheter (1.92 catheter per person).There were 4/61 (6.5%) patients with catheter‐related complications without prior phlebography and CT venography. Phlebography and CT venography were performed in 30 (24.0%) patients with suspected CVS/thrombosis and with dialysis vintage of 76.23 months (52.78–98.28). Phlebography and CT venography were more sensitive than color doppler in the detection of CVS/thrombosis in patients with prior permanent catheter placements (P < 0.001). Since this diagnostic algorithm was introduced prior to catheter placement there were no catheter insertion‐related complications or dysfunctions (P < 0.001). All our procedures on patients with prior permanent catheters followed preliminary color doppler diagnostics. Nevertheless, in four cases, the vessel obstruction and abnormality led to catheter insertion‐related complications. When phlebography and CT venography was performed before the procedure in patients with prior permanent catheters and one or more CVS or thrombosis, early and late catheter‐related complications were avoided by careful selection of the least injured vein and planning of procedure. When planning a permanent dialysis catheter placement in patients with prior multiple CVC, phlebography and CT venography may be diagnostic procedures of choice for avoidance of early catheter dysfunction and CVC placement complications.

Changes in indications for therapeutic plasma exchange over the last 27 years in Croatia.

Results from recent trials and advances in the fields of medicine and technology have altered the spectrum of indications for use of therapeutic plasma exchange. In this article we analyze changes in indications for therapeutic plasma exchange that have occurred during 27 years in Croatia. We retrospectively analyzed the database of the Department of Dialysis at the University Hospital Center, Zagreb (678 patients; 6596 procedures), for changes in indications for therapeutic plasma exchange from 1982 to 2008. The number of patients and procedures increased several‐fold during the follow‐up period, but the mean number of procedures per patient per year did not change significantly. Neurological disorders constituted the largest group of indications for therapeutic plasma exchange (66% of all indications), followed by hematological (16%), nephrological (6%), and rheumatological disorders (6%). Myasthenia gravis was the most frequent indication during the entire follow‐up period, but the pattern of other indications changed, with the most frequent at the beginning of follow‐up becoming the least frequent at the end of follow‐up. The five most frequent indications represented 62.2% of all indications at the beginning of follow‐up, whereas during the 1990s, this percentage increased to more than 90% of all indications. Since the year 2000, the spectrum of indications has grown, and the percentage of the five most common indications decreased to 79.9%. Despite changes in indications for therapeutic plasma exchange, this procedure is still applicable in various medical fields, either traditional or newly created with the development of medicine and technology.

Membrane therapeutic plasma exchange with and without heparin anticoagulation

Administration of an anticoagulant during therapeutic plasma exchange (TPE) is necessary to avoid circuit clotting and impaired treatment effectiveness. Citrate is the preferred anticoagulant for apheresis worldwide, and unfractionated heparin (UH) is the second most preferred, yet there are only a few published studies regarding the use of UH during TPE. There are even fewer studies regarding the use of low‐molecular‐weight heparin (LMWH) and TPE performed without anticoagulation.

The Different Impacts on the Long-Term Survival of Tunneled Internal Jugular Hemodialysis Catheters Based on Tip Position and Laterality

Background/Aims: The aim of this study was to examine the impact of different catheter tip positions on the life of the catheter, dysfunction, infection, and quality of hemodialysis and possible differences between the access site laterality in jugular-tunneled hemodialysis catheters. Methods: Catheters were evaluated for the following parameters: place of insertion, time of insertion, duration of use, and reason for removal. In all patients, the catheter tip position was checked using an X-ray. Results: The mean duration of implanted catheters with the tip placed in the cavo-atrial junction and right atrium was significantly longer. There were no differences in catheter functionality at follow-up or complications based on catheter laterality for each catheter tip position. Conclusion: According to our results, the localization of the catheter tip in superior vena cava still remains the least preferable method. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth to which the catheter tip is inserted into the body.