COMPARISON BETWEEN INTERNAL JUGULAR VEIN AND SUBCLAVIAN VEIN DOUBLE LUMEN CATHETER CANNULATION, CATHETER RELATED INFECTIONS AND COMPLICATIONS IN HEMODIALYSIS PATIENTS
Main Article Content
Keywords
Renal failure, double lumen internal jugular vein catheter, double lumen subclavian vein catheter, hemodialysis, complications
Abstract
Introduction: Hemodialysis (HD) is a technique chosen as a substitute for renal function to support the life of patients with low-grade morbidity and renal failure. Vascular access is a critical concern in patients undergoing long-term hemodialysis (HD). Limited data is available regarding the safety analysis of venous catheter-associated complications in local healthcare settings. Internal jugular vein double-lumen catheterization and subclavian vein double-lumen catheterization is be compared in terms of bacterial infection-related adverse effects in a randomized controlled study. This study aimed to identify the safest catheterization technique to decrease significant morbidity-related concerns in patients with renal disease.
Methodology: A comparative prospective study with a cohort of 218 patients (sample size determined by WHO sample size calculator) with renal failure requiring hemodialysis was selected from the Department of Nephrology, Pakistan Institute of Medical Sciences, SZABMU, Islamabad, and were divided into group A (double-lumen internal jugular vein catheter) and group B (double-lumen subclavian vein catheter) after fulfilling the selection criteria. The collected data were analyzed using SPSS version 23.
Results: In groups A and B, complications included procedure failure (18.3% vs. 8.3%), bleeding and hematoma formation (11.0% vs. 3.7%), arterial puncture (10.1% vs. 2.8%), and infection (14.7% vs. 4.6%). In group A, 32.1% of patients had positive culture reports, while in group B, 14.7% of patients had a positive culture report with p value (p=0.002).
Conclusion: Double-lumen subclavian vein catheterization had better outcomes than double-lumen internal jugular vein catheterization in terms of accessibility, infection, and complications.
References
2. Moini M, Rasouli MR, Kenari MM, Mahmoodi HR. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients. Saudi J Kidney Dis Transpl. 2009;20(1):44-8.
3. Moini M, Rasouli MR, Kenari MM, Mahmoodi HR. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients. Saudi J Kidney Dis Transpl. 2009;20(1):44-8.
4. Pierson D. Respiratory considerations in the patient with renal failure. Respir Care. 2006 May 1;51:413–22.
5. Sepas HN, Negahi A, Mousavie SH, Vosough F, Farazmand B. Patency and outcomes of tunneled hemodialysis catheter via femoral versus jugular vein access. J Adv Pharm Technol Res. 2019;10(2):81.
6. Judith L. Vogelzang and others, Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry, Nephrology Dialysis Transplantation, Volume 30, Issue 6, June 2015, Pages 1028–1037, https://doi.org/10.1093/ndt/gfv007
7. Renal Fellow Network. What are Survival Rates for Patients on Dialysis? - Renal Fellow Network [Internet]. 2018. Available from: https://www.renalfellow.org/2018/09/19/what-are-survival-rates-for-dialysis-patients/
8. Subramayam T, Vakrani GP. Hemodialysis catheter related blood stream infections. Int J Res Med Sci. 2018;6(2):562-6.
9. Moini M, Rasouli MR, Kenari MM, Mahmoodi HR. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients. Saudi J Kidney Dis Transpl. 2009;20(1):44-8.
10. Marques MG, Maia P, Ponce P. Dialysis catheter malfunction. Port J NephrolHypert. 2017;31(3):184-91.
11. Hemachandar R. Practice pattern of hemodialysis among end-stage renal disease patients in Rural South India: A single-center experience. Saudi J Kidney Dis Transpl. 2017;28(5):1150-6.
12. Stephen Fletcher, MB BS FRCA MRCP(UK) FJFICM, Catheter-related bloodstream infection, Continuing Education in Anaesthesia Critical Care & Pain, Volume 5, Issue 2, April 2005, Pages 49–51, https://doi.org/10.1093/bjaceaccp/mki011
13. S.H. Kim, K.I. Song, J.W. Chang, S.B. Kim, S.A. Sung, S.K. Jo, W.Y. Cho, H.K. Kim, Prevention of uncuffed hemodialysis catheter-related bacteremia using an antibiotic lock technique: A prospective, randomized clinical trial, Kidney International, 69(1), 161-164, DOI:https://doi.org/10.1038/sj.ki.5000012
14. Suzuki M, Satoh N, Nakamura M, Horita S, Seki G, Moriya K. Bacteremia in hemodialysis patients. World Journal of Nephrology. 2016 Nov 11;5(6):489.
15. Chow KM, Li PK-T, Cho Y, et al. ISPD Catheter-related Infection Recommendations: 2023 Update. Peritoneal Dialysis International.2023;43(3):201-219. doi:10.1177/08968608231172740
16. Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. Journal of infection and public health. 2017;10(4):403-8.
17. Bond A, Chadwick P, Smith TR, Nightingale JMD, Lal S. Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition. Frontline Gastroenterol [Internet]. 2020;11(1):48–54. Available from: https://fg.bmj.com/content/11/1/48
18. Shahar S, Mustafar R, Kamaruzaman L, Periyasamy P, Pau KB, Ramli R. Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes. International journal of nephrology. 2021;2021.
19. Deawtrakulchai P, Cheawchanwattana S, Sribenjalux W, Meesing A. The comparative accuracy of pooled vs. individual blood culture sampling methods for diagnosis of catheter-related bloodstream infection. BMC Infect Dis. 2022 Jul 17;22(1):622. doi: 10.1186/s12879-022-07605-x. PMID: 35843933; PMCID: PMC9290260.
20. Raji YR, Ajayi SO, Aminu O, Abiola B, Efuntoye O, Salako BL, et al. Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria. Pan Afr Med J. 2018;31(1).
21. Intravascular catheter-related infection: Epidemiology, pathogenesis, and microbiology - UpToDate, https://www.uptodate.com/contents/intravascular-catheter-related-infection-epidemiology-pathogenesis-and-microbiology
22. Masoodi I, Alharth FR, Irshad S, Mastan AR, Alzaidi A, Balbaid KA, et al. Hemodialysis catheter-related infections: results of a tertiary care center study in Saudi Arabia. Int J Med Sci Public Health. 2019;8(4):319-25.
23. Karunaratne K, Taube D, Khalil N, Perry R, Malhotra PA. Neurological complications of renal dialysis and transplantation. Pract Neurol. 2018;18(2):115-25.
24. Saha M, Allon M. Diagnosis, treatment, and prevention of hemodialysis emergencies. Clin J Am SocNephrol. 2017;12(2):357-69.
25. MasudA,CostanzoEJ,ZuckermanR,Asif A, The Complications of Vascular Access in Hemodialysis. Seminars in thrombosis and hemostasis. 2018 Feb; [PubMed PMID: 28898900]
26. Baang JH, Inagaki K, Nagel J, et al. Inpatient Diagnosis and Treatment of Catheter-Related Bloodstream Infection [Internet]. Ann Arbor (MI): Michigan Medicine University of Michigan; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589895/
27. Li, Yue& Wu, Weidong& Liu, Weihong& Zhou, Mingxue. (2020). Roles and mechanisms of renalase in cardiovascular disease: A promising therapeutic target. Biomedicine & pharmacotherapy = Biomedecine&pharmacotherapie. 131. 110712. 10.1016/j.biopha.2020.110712.
28. Bond A, Chadwick P, Smith TR, et al, Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition, Frontline Gastroenterology 2020;11:48-54.
29. Kaplowitz, L., Cornstock, J., Landwehr, D., Dalton, H., &Mayhall, C. (1988). A Prospective Study of Infections in Hemodialysis Patients: Patient Hygiene and Other Risk Factors for Infection. Infection Control & Hospital Epidemiology, 9(12), 534-541. doi:10.1086/645772
30. Delistefani, F., Wallbach, M., Müller, G.A. et al. Risk factors for catheter-related infections in patients receiving permanent dialysis catheter. BMC Nephrol 20, 199 (2019). https://doi.org/10.1186/s12882-019-1392-0
31. Sangadji D, wardanaaditia, Tjempakasari A, Alimsardjono L. Association between the Biofilm of Double-Lumen Catheter and Blood Culture in Hemodialysis Patients with Suspected Central Line-Associated Bloodstream Infection. Indones J Kidney Hypertens. 2020 Apr 20;3.
32. Lin, Z. H., &Zuo, L. (2015). When to initiate renal replacement therapy: The trend of dialysis initiation. World journal of nephrology, 4(5), 521–527. https://doi.org/10.5527/wjn.v4.i5.521
33. ShamiraShahar, RuslindaMustafar, Lydia Kamaruzaman, PetrickPeriyasamy, Kiew Bing Pau, RamlizaRamli, "Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes", International Journal of Nephrology, vol. 2021, Article ID 5562690, 9 pages, 2021. https://doi.org/10.1155/2021/5562690
34. Singh S, Dwivedi D, Taank P. Ultrasound-assisted Rare Case of Misplaced Hemodialysis Catheter. Journal of Medical Academics. 2019;2(2):1-6.
35. Pitiriga, V., Bakalis, J., Theodoridou, K. et al. Comparison of microbial colonization rates between central venous catheters and peripherally inserted central catheters. Antimicrob Resist Infect Control 12, 74 (2023). https://doi.org/10.1186/s13756-023-01285-1
36. Breschan C, Platzer M, Jost R, Schaumberger F, Stettner H, Likar R. Comparison of catheter-related infection and tip colonization between internal jugular and subclavian central venous catheters in surgical neonates. The Journal of the American Society of Anesthesiologists. 2017;107(6):946-53.
37. Khalid M, Malik MA. Comparison of internal jugular vein with subclavian vein hemodialysis catheter access. Journal of University Medical & Dental College. 2017;8(1):14-8.
38. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2017;40(8):2479-85.
39. Perforation V. BirKateterKomplikasyonu: VenPerforasyonu ve AkciğerHasarı. Turk J AnaesthReanim. 2014;42:270-2.
40. Goraya S, Sharif MA, Ahmed U, Maqbool F, Rizvi TH. Complications of Insertion of Double Lumen Catheter in Subclavian Vein in Patients of Renal Failure. Annals of Punjab Medical College (APMC). 2016;10(2):63-6.
41. D'Agata EMC. Addressing the Problem of Multidrug-Resistant Organisms in Dialysis. Clin J Am SocNephrol. 2018 Apr 6;13(4):666-668. doi: 10.2215/CJN.13781217. Epub 2018 Mar 22. PMID: 29567862; PMCID: PMC5968912
42. Akash, M.S.H., Rehman, K., Fiayyaz, F. et al. Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies. Arch Microbiol 202, 953–965 (2020). https://doi.org/10.1007/s00203-020-01818-x
43. Takeshita, J., Tachibana, K., Nakajima, Y. et al. Incidence of catheter-related bloodstream infections following ultrasound-guided central venous catheterization: a systematic review and meta-analysis. BMC Infect Dis 22, 772 (2022). https://doi.org/10.1186/s12879-022-07760-1
44. Practice Guidelines for Central Venous Access 2020 | Anesthesiology | American Society of Anesthesiologists (asahq.org), https://pubs.asahq.org/anesthesiology/article/132/1/8/108838/Practice-Guidelines-for Central-Venous-Access
45. Masoodi I, Alharth FR, Irshad S, Mastan AR, Alzaidi A, Balbaid KA, et al. Hemodialysis catheter-related infections: results of a tertiary care center study in Saudi Arabia. Int J Med Sci Public Health. 2019;8(4):319-25.
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Adnan Mushtaq
Senior Registrar, Quaid-e-Azam International Hospital, Islamabad
Hamza Shafiq
House Officer, Quaid-e-Azam International Hospital, Islamabad
Uzzam Ali
House-Officer, Quaid-e-Azam International Hospital, Islamabad
Fatima Abdul Hameed
Post-graduate Resident, General Medicine, Quaid-e-Azam International Hospital, Islamabad
Amna Akbar
Female Medical Officer, District Headquarter Hospital, Hattian Bala, AJK, Pakistan
Farwa Kazmi
Medical Officer, Quaid-e-Azam International Hospital, Islamabad
Sarosh Khan Jadoon
Resident Surgery, Combine Military Hospital, Muzaffarabad, AJK, Pakistan
Raja Muhammad Ijaz Khan
Professor of Surgery AJK Medical College, Muzaffarabad, AJK, Consultant Surgeon, Combine Military Hospital, AJK, Muzaffarabad, Pakistan
Sabahat Tasneem
Public Health Professional, MSPH Health Services Academy, Islamabad, Pakistan