Author

Shreya Sood

Date of Award

11-3-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Michael Tal

Abstract

Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may decrease their occurrence. We predict that over time, chronic catheter use decreases the mean indwell time for each catheterization and increases the incidence of complications. To study this, we conducted a retrospective study looking at all patients who had three or more tunneled catheter exchanges between July 2003 and July 2008. We collected information from Yale IDX database on the patients age and gender, the type of catheter used, the indwell time of the catheter, the vessel used as access, the indication for catheter removal, whether the procedure was performed by a medical doctor (M.D.) or physicians assistant (P.A.) and whether it was a de novo insertion or over-the-wire exchange. We collected a total of 764 data points on 191 patients (89 males and 102 females). They ranged from 8 to 87 years old with a median age of 56 years. Infection was the number one indication for catheter removal at 37%. The rate of infection was 3.34 per 1,000 catheter days. There was no difference in the rate of complications by the side of vessel accessed nor by type of catheter. However, right-sided catheters had a longer indwell time of 117 + 159 days compared to left-sided catheters, 87 + 124 days (p =0.008). There was no significant difference in the indwell duration of first catheter in comparison to all subsequent placements. There was also no difference in complications whether the catheter was exchanged over the wire or placed de novo. Nor were complication rates different among M.D. versus P.A. conducted procedures. We conclude that our rates of infection are similar to other institutions and the vessels located on the right-side of the neck are preferable to left-sided vessels to increase catheter longevity. Future research is needed to better assess how rates and incidences of complications change with long standing catheter-reliance.

Comments

This is an Open Access Thesis.

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