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  • Honorary Editor: Diego Brancaccio
  • Coordinating Editor: Maurizio Gallieni
  • Editor in Chief VAS: Jan Tordoir
  • Frequency: Bimonthly
  • Current issue: Vol. 15 issue 4 , 2014 (July-August)

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Vol. 14 Issue 2 (April-June)

Does prophylactic anticoagulation reduce the risk of femoral tunneled dialysis catheter-related complications

Does prophylactic anticoagulation reduce the risk of femoral tunneled dialysis catheter-related complications

J Vasc Access 2013; 14(2): 135 - 142

Article Type: ORIGINAL ARTICLE

DOI:10.5301/jva.5000117

Authors

William G. Herrington, Helen J. Nye, Richard J. Haynes, Christopher G. Winearls, Emma C. Vaux

Abstract

Purpose: To determine the incidence and predictors of femoral tunneled dialysis catheter (TDC)-related complications and whether prophylactic anticoagulation is associated with reduced catheter-related deep vein thrombosis (CRT) or prolonged patency. Methods: A retrospective review of femoral TDCs inserted for maintenance hemodialysis in patients from two dialysis units that have used two different strategies to reduce thrombotic complications. One center routinely considered all femoral TDCs for prophylactic anticoagulation, whilst the other restricted anticoagulation to TDCs that had required repeated treatment with urokinase locks to maintain patency. Survival analyses were performed to establish complication rates, identify predictors of complications and assess the effect of prophylactic anticoagulation use. Results: Of the 194 femoral TDCs identified, 178 (92%) were associated with at least one complication. Approximately three quarters did not provide adequate small solute clearance; one half were not in use by three months; one quarter had at least one catheter-related infection (2.3 per 1000 catheter days); and one in ten developed a CRT (1.1 per 1000 catheter days). Prophylactic anticoagulation was not associated with significant improvements in rates of catheter occlusion, CRT, catheter-related infection or dialysis adequacy. A previous ipsilateral femoral TDC was identified as a statistically significant predictor of a CRT (adjusted hazard ratio 3.7 [95% confidence interval 1.4-9.8]; P=.007). Conclusions: Femoral TDCs are associated with poor patency rates and high complication rates; reusing femoral veins for TDCs should be avoided where possible, and this study provides no evidence to support routine prophylactic anticoagulation in all patients with femoral TDCs.

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Authors

  • Herrington, William G. [PubMed] [Google Scholar]
    Oxford Kidney Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford - UK
  • Nye, Helen J. [PubMed] [Google Scholar]
    Royal Berkshire Hospital Renal Department, Royal Berkshire NHS Foundation Trust, Reading - UK
  • Haynes, Richard J. [PubMed] [Google Scholar]
    Oxford Kidney Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford - UK
  • Winearls, Christopher G. [PubMed] [Google Scholar]
    Oxford Kidney Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford - UK
  • Vaux, Emma C. [PubMed] [Google Scholar]
    Royal Berkshire Hospital Renal Department, Royal Berkshire NHS Foundation Trust, Reading - UK

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