OJRad  Vol.2 No.3 , September 2012
Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction
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.

Cite this paper
K. Burton, J. O'Brien and D. Rajan, "Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction," Open Journal of Radiology, Vol. 2 No. 3, 2012, pp. 57-64. doi: 10.4236/ojrad.2012.23011.
[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.