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Minerva Urology and Nephrology 2021 Jun 11

DOI: 10.23736/S2724-6051.21.04222-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Non-tunneled catheter tip depth position in urgent hemodialysis. A randomized controlled trial

Héctor R. IBARRA-SIFUENTES 1, 2, 3, 4, 5 , José F. SÁNCHEZ-SERNA 6, Sergio A. CASTILLO-TORRES 3, 7, Raymundo VERA-PINEDA 8, Jesús E. CUELLAR-MONTERRUBIO 9, Cesar O. PEZINA-CANTÚ 10, Sergio R. ALVIZURES-SOLARES 4, María G. RAMÍREZ-RAMÍREZ 4, José L. AVILA-VELÁZQUEZ 4, Elisa M. G. GUERRERO-GONZÁLEZ 4, Concepción SÁNCHEZ-MARTÍNEZ 4

1 Department of Internal Medicine, Hospital General de Zona 11, Instituto Mexicano del Seguro Social, Piedras Negras, Coahuila, México; 2 Nephrology Service, Hospital General de Zona 11, Instituto Mexicano del Seguro Social, Piedras Negras, Coahuila, México; 3 Internal Medicine Department, University Hospital, Autonomous University of Nuevo León, Monterrey, México; 4 Nephrology Service, University Hospital, Autonomous University of Nuevo León, Monterrey, México; 5 Escuela de Medicina Unidad Norte, Universidad Autónoma de Coahuila, Piedras Negras, Coahuila, México; 6 Nephrology Service, Hospital General de Chetumal, Secretaría de Salud, Chetumal, Quintana Roo, México; 7 Neurology Service, University Hospital, Autonomous University of Nuevo León, Monterrey, México; 8 Cardiology Service, University Hospital, Autonomous University of Nuevo León, Monterrey, México; 9 Gastroenterology Service, University Hospital, Autonomous University of Nuevo León, Monterrey, México; 10 Hematology Service, Hospital Constitución, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Monterrey, México


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BACKGROUND: The average accepted depth for Non-Tunneled Catheters (NTC) insertion does not guarantee its correct position, so controversy exists. The aim is to assess the effect of two NTC placement depths on the number of NTC complication episodes.
METHODS: We designed a triple blind, parallel-group, randomized controlled trial in a single Hemodialysis Center in Mexico (Registry: ACTRN12619000774123). We included patients in urgent need of hemodialysis via internal right jugular vein NTC. The length of the NTC tip placement depth was randomized to second intercostal space (2ICS) or fourth intercostal space (4ICS), using physical landmarks. The primary outcome is to compare the composite number of NTC dysfunction, repositioning, and relocation episodes during 48 hours post procedure.
RESULTS: One hundred and sixty five patients were included, 86 and 79 patients to NTC placement in the 2ICS and 4ICS, respectively. All patients underwent intention-to treat analysis. The incidence of the composite outcome was lower in the 2ICS group compared to the 4ICS group, 4 (4.6%) and 50 (63%) combined episodes, respectively (p <0.001). Compared to the 4ICS group, the 2ICS group presented a relative risk of 0.06 (IC 0.02-0.21, p <0.001) and number needed to treat (NNT) of 2.1. No adverse events occur derived from the NTC placement.
CONCLUSIONS: NTC tip placement in the 2ICS compared to 4ICS decreases the incidence of the combined number of dysfunction, repositioning and relocation episodes, with a NNT of 2 for its prevention.


KEY WORDS: Catheter; Hemodialysis; Non-tunneled catheters; Ultrasound; Uremia; Jugular vein

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