Catheter dysfunction

Little MA, Walshe JJ. A longitudinal study of the repeated use of alteplase as therapy for tunneled hemodialysis catheter dysfunction. Am J Kidney Dis 2002 39 86-91. 

Table 6.1. NAVAN consensus conference on the treatment of thrombotic catheter dysfunction...

Haire WD, Herbst SL (2000) The use of alteplase (t-PA) for the management of thrombotic catheter dysfunction. Clinician 18 5-16... 

Niyyar VD Catheter dysfunction the role of lock solutions. Sem Dial 2012 25 693-699. 

Niyyar VD, Chan MR Interventional nephrology catheter dysfunction - prevention and troubleshooting. Clin J Am Soc Nephrol 2013 8 1234-1243. 

PD complications can be divided into acute or chronic and infectious or noninfectious. Imaging with ultrasound, CT, and eventually MRI can contribute significantly to appropriate treatment of many situations (Taylor 2002). Acute catheter dysfunction may be caused by malposition and can be seen on a plain abdominal radiograph. Development of inguinal hernias is caused by the permanently increased intra-abdominal pressure, and herniotomy is frequently needed. Acute respiratory distress should raise suspicion of hydrothorax caused by thoracic leakage of peritoneal fluid (Rose and Conley 1989). A chest X-ray can show this complication (Fig. 21.3). Infections of the exit site, the subcutaneous tunnel, and peritonitis are the most common infectious complications. Proper treatment with intraperitoneal antibiotics is mandatory. The incidence of peritonitis is estimated to be one infection per 13 treatment months. Recurrent peritonitis may lead to catheter removal. Tunnel infections typically show pericatheter fluid collection, and US is important for early detection and follow-... 

Myocardial ischemia and infarction cause abnorma myocardial metabolism, decreased left ventricular (LV) systolic function, diastolic dysfunction, congestive heart failure, and decreased survival. Consequently, revascularization techniques, either surgical or catheter based, have become integral to treatment of severe ischemic heart disease. 

Pasquier Y, Cahana A, Schnider A. Subdural catheter migration may lead to baclofen pump dysfunction. Spinal Cord. 2003 41 700-702. 

Common problems in the past were fat overload syndrome, metabolic acidosis, hyperglycemia, and hypertriglyceridemia (6). These problems are now rare. Increasing efforts have been made to avoid adverse effects such as central venous catheter infection and hepatic dysfunction. Major developments in the future are likely to be achieved with the identification of nutrients, hormones, or other active compounds that can positively influence outcome beyond the safe provision of 40 essential nutrients in proper amounts, which is what principally has been achieved to date (7). Liver damage is still a major problem. The most common micronutrient deficiency is of thiamine. 

Thrombosis of the vascular access is a major problem in chronic HD. Although thrombosis occurs in grafts, and to a lesser extent Hs-tulas, thrombosis associated with catheters is the most problematic and will be the focus of discussion here. Early dysfunction (less than 5 days after placement) of an HD catheter is usually associated with an intracatheter or catheter-tip thrombosis, or a malpositioned catheter. Thrombi that occur after approximately 1 week can be outside the catheter (extrinsic) or within the catheter (intrinsic). Intrinsic throm-... 

Hifleman DE, Dunlay RW, Packard KA. Reteplase for dysfunctional hemodialysis catheter clearance. Pharmacotherapy 2003 23 137-141. 

An embolus to the MCA is common and can cause a catastrophic stroke. It is also amenable to rapid therapy. For these reasons, special emphasis is placed here on this stroke subtype. As discussed above, carotid stenosis and occlusion can cause stroke by artery-to-artery embolus to the MCA territory or by causing a low-flow state [17]. Distinguishing features of carotid stenosis include the common occurrence of multiple stereotypic spells of transient ipsilateral hemispheric or monocular dysfunction. In addition, in carotid stenosis multiple emboli may occur over a short period of time. In some cases of embolus to the MCA from a severely stenotic carotid, the embolus may be less well tolerated and the stroke more severe due to the lower perfusion pressure above the carotid lesion [17]. Embolus from the carotid to the MCA can also occur from the stump of a completely occluded carotid [59]. If the occlusion is hyperacute, often the absence of flow in the region fi om the carotid bulb to the distal ICA reflects coUapse of the lumen due to low pressure rather than occlusion of the entire carotid with thrombus. In these cases, it is sometimes possible to dissolve the fresh clot in the extracerebral portion of the carotid and advance a catheter to treat the intracerebral clot. This can be... 

Cox K, Vesely TM, Windus DW, Pilgram TK (2000) The utility of brushing dysfunctional hemodialysis catheters. J Vase Interv Radiol 11 979-983... 

Krutchen AE, Bjarnason H, Stackhouse DJ, Nazarian GK, Magney JE, Hunter DW (1996) The mechanisms of positional dysfunction of subclavian venous catheters. Radiology 200 159-163... 

The tunica albuginea is reapproximated with 3-0 Polydioxanone suture. Finally, the Buck s fascia, dar-tos and skin are sutured. The urethral catheter is left in place for 2-3 weeks. Postoperative complications include erectile dysfunction, strictures of the urethra and necrosis of distal portions of the shaft or glans. 

Brewington SD, Abbas AA, Dbton SR, Grines CL, O Neill WW. Reproducible microvascular dysfunction with dobuta-mine infusion in Takotsubo cardiomyopathy presenting with ST segment elevation. Catheter Cardiovasc Interv 2006 68(5) 769-74. 

Stenosis is a common problem for AVFs and AVGs and represents the main cause of dysfunction and thrombosis, and the choice of the best method for repair depends on the location of the lesion. Access stenosis has been classified based on its location as juxta-anastomotic (type I), in the cannulable segment (type II) and at the outflow into the deep venous system (type III) [4] (fig. 1). There are two additional categories of stenoses not involving the access itself, those of the central veins caused by longstanding catheters and those of the arterial inflow [5]. 

K/DOQI guidelines on VA [5] say that dysfunctional catheter is usually easier to salvage than a nonfunctional one . To detect a tCVC malfunction at its starting phase may be accomplished by regular monitoring. It can also serve as a supporting tool for decision on an intervention. For reliable detection of trends, monitoring should be done in a standardized way. The pressure/flow characteristics appear most suitable for this as both pre-pump pressure (PA) and pressure in the venous drip chamber (PV) and blood flow (Qb) are displayed on each dialysis machines. 

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