Is guidewire exchange a better approach for subclavian vein re-catheterization for chronic hemodialysis patients?

Hou, Shaw-Min; Chou, Po-Ching; Huang, Chi-Hung; Chin, Chih-Hui; Wang, Pa-Chun; Chen, Ya-Hui

doi:10.1016/j.thromres.2005.08.010

« Previous Next »Thrombosis Research
Volume 118, Issue 4 , Pages 439-445, 2006

Is guidewire exchange a better approach for subclavian vein re-catheterization for chronic hemodialysis patients?

Shaw-Min Hou
- Department of Cardiovascular Surgery, Cathay General Hospital, Taipei, Taiwan
Po-Ching Chou
- Department of Cardiology, Cathay General Hospital, Taipei, Taiwan
Chi-Hung Huang
- Department of Cardiology, Cathay General Hospital, Taipei, Taiwan
Chih-Hui Chin
- Department of Cardiology, Cathay General Hospital, Taipei, Taiwan
Pa-Chun Wang
- Cathay Medical Research Institute, Cathay General Hospital, Taipei, Taiwan
- Fu Jen Catholic University School of Medicine, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Corresponding author. Cathay Medical Research Institute, Cathay General Hospital, 280 Sec. 4, Jen-Ai Rd. 106 Taipei, Taiwan. Tel.: +886 2 27082121x3333; fax: +886 2 27074949.
Ya-Hui Chen
- Cathay Medical Research Institute, Cathay General Hospital, Taipei, Taiwan

Received 19 June 2005; received in revised form 17 August 2005; accepted 19 August 2005.

Abstract

Background

The objectives of this study were to compare outcomes and survival rates of subclavian vein re-catheterization through guide wire exchange (GWE) or de novo insertion (DN).

Materials and methods

The study was conducted in a retrospective manner. Medical records of 36 patients who received percutaneous subclavian vein re-catheterization for hemodialysis in our institution during the period from April 1, 2001 to September 30, 2004 were reviewed. All patients had at least 2 catheter insertions records in our institute. Incidences of adverse events (infection, thrombosis) were compared between GWE and DN groups using x² test. Predictors for adverse event occurrences were analyzed using logistic regression models. Cox proportional hazard model was used to investigate the predictors for adverse event-free catheter days. Kaplan-Meire survival curves were computed and compared using log rank test.

Results

Information were generated from 98 catheters (41 from DN, 57 from GWE groups). The average catheter usage was 2.8±0.9 devices per patient and the mean catheter-indwelling-day was 125.4±129.5 days in this cohort. We found GWE group had significantly lower thrombosis rate (49.1% vs. 85.4% for DN group, P<0.000) in general. Surgical approach was a significant risk factors for catheter thrombosis (GWE vs. DN, odds ratio=0.261, P=0.05). The actuarial survival rates for GWE were ≧30 days, 85.4%; ≧60 days, 75.5%; ≧90 days, 64.5%; ≧180 days, 44.3%. The actuarial survival rates for DN were ≧30 days, 70.7%; ≧60 days, 58.5%; ≧90 days, 34.2%; ≧180 days, 18.4%. GWE group catheters had significantly higher catheter survival rates (P=0.0009). Mahukar catheter (hazard ratio 0.514, P=0.03), non-shock (hazard ratio 3.358, P=0.04), and older age (hazard ratio 0.958, P=0.026) were predictors of adverse event-free remaining catheter days.

Conclusion

We suggest that GWE might be a favorable option over DN insertion when revised subclavian vein catheterization is inevitable. GWE can be performed repeatedly without compromising catheter outcomes.

Keywords: Subclavian vein re-catheterization, Catheter thrombosis, Guidewire exchange, De novo insertion