Tunneled dialysis catheter placement within intensive care unit (ICU) patients: influence of catheter tip design on clinical performance

Sunday, March 5, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 222AB

Presenting Author(s)

AG

Alexey Gurevich, MD, MS

Resident
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Matthew Hung, MD (he/him/his)

Interventional Radiology Resident
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
FL

Fang Liu, MPH

Biostatistician
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
QC

Quy Cao, PhD

Biostatistician
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
RC

Raphael Cohen, MD

Attending Physician
Division of Nephrology, Department of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
Ansar Z. Vance, MD

Attending Physician
University of Pennsylvania
Timothy W.I Clark, MD, MS

Professor
University of Pennsylvania

Disclosure(s):

Alexey Gurevich, MD, MS: No financial relationships to disclose

Matthew Hung, MD: No financial relationships to disclose

Ansar Z. Vance, MD: No relevant disclosure to display

Timothy W.I Clark, MD, MS: No relevant disclosure to display

Purpose: Tunneled dialysis catheter tip design may affect freedom from catheter dysfunction and/or infection; improved performance within a critical care setting may reduce costs and need for catheter guidewire exchange or removal. This study compared rates of catheter failure between a symmetrical, helical-tip catheter (VectorFlow) with a conventional split-tip catheter (Ash-Split) among ICU patients undergoing tunneled dialysis catheter placement.

Materials and Methods: A retrospective database identified a total of 1734 tunneled dialysis catheters placed at an academic institution over a 7-year period. Of these, 340 catheters (19.6%) were placed within ICU patients, which included VectorFlow (n=112, 32.9%) and Ash-Split (n=228, 67.1%) catheters. Rates of catheter failure requiring guidewire exchange or removal from a composite outcome of malfunction or infection were compared with Kaplan Meier estimates, and covariates potentially influencing catheter failure were assessed with Cox proportional hazards modeling.

Results: Catheter failure occurred within 90 days in 34.8 ± 3.4% of ICU patients. Among patients with VectorFlow catheters, primary unassisted patency at 30, 60, 90 and 180 days was 87.4 ± 3.6%, 78.0 ± 5.1%, 75.1 ± 5.0% and 60.1 ± 8.2% compared to 75.0 ± 3.3%, 62.8 ± 4.1%, 60.7 ± 4.2% and 44.3 ± 5.5% among patients with Ash-Split catheters (p=0.022). Cox modeling of body mass index, patient age, sex, left jugular (vs. right) placement and indication for placement (initiation of hemodialysis access vs. failed surgical arteriovenous access) showed no effect on catheter patency; patients with Ash-Split catheters had a hazard ratio of catheter failure 1.72 times higher than patients with VectorFlow catheters (p=0.024) in univariate modeling and a hazard ratio of 1.81 in multivariate modeling (p=0.017).

Conclusion: The VectorFlow catheter was associated with significantly higher rates of primary patency than the Ash-Split catheter among ICU patients, independent of multiple clinical and anatomic factors. These data support a VectorFlow-first placement strategy within this patient population.