PMID- 34579540
OWN - NLM
STAT- MEDLINE
DCOM- 20220422
LR  - 20220427
IS  - 1488-2361 (Electronic)
IS  - 0846-5371 (Linking)
VI  - 73
IP  - 2
DP  - 2022 May
TI  - Factors Affecting Cuff Extrusion of Tunneled Hemodialysis Catheters.
PG  - 410-418
LID - 10.1177/08465371211041241 [doi]
AB  - PURPOSE: To identify patient and procedural factors associated with extrusion of 
      the Dacron cuff from the subcutaneous tunnel of tunneled hemodialysis catheters 
      (THDCs). MATERIALS AND METHODS: Single center 5-year retrospective analysis of 
      625 catheters in 293 adult patients. Patient data included age, gender, body mass 
      index (BMI), and common comorbidities. Procedural details included type of 
      procedure (new insertion vs. exchange), operator seniority, side of insertion, 
      catheter model and presence of catheter wings skin-sutures. Complications were 
      reported as cumulative risk over time and Cox proportional hazards model was used 
      to evaluate risk factors for cuff extrusion (CE). RESULTS: Median patient 
      follow-up was 503 days (188,913 catheter-days) and median catheter survival 163 
      days. CE occurred in 23.8% of catheters, at a rate of 0.79 per 1,000 
      catheter-days and a median time of 64 days. It was more common than infection 
      (14.6%) and inadequate flow (15.5%). The 1-month and 12-month risk of CE was 5.9% 
      and 21.3% respectively. A first episode of CE was a strong predictor of future CE 
      episodes. The only patient factor that affected the risk of CE was BMI (Hazard 
      Ratio 2.36 for obese patients). Procedural factors that affected the risk of CE, 
      adjusted for BMI, were catheter model, type of procedure (lower risk for new 
      insertions) and catheter wings skin-sutures; the latter reduced the 30-day CE 
      risk by 76% without increasing catheter-related infections. CONCLUSION: Cuff 
      extrusion is common in long-term THDCs. The risk increases with obesity, history 
      of previous cuff extrusion, certain catheter models and absence of wing-sutures.
FAU - Parvulescu, Flavius
AU  - Parvulescu F
AUID- ORCID: 0000-0002-9315-242X
AD  - Interventional Radiology Department, Sunnybrook Health Sciences Centre, Toronto, 
      Ontario, Canada.
FAU - Oliver, Matthew J
AU  - Oliver MJ
AD  - Department of Medicine, University of Toronto, Ontario, Canada.
FAU - Reyna, Myrtha E
AU  - Reyna ME
AD  - Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, 
      Canada.
FAU - Pugash, Robyn
AU  - Pugash R
AD  - Interventional Radiology Department, Sunnybrook Health Sciences Centre, Toronto, 
      Ontario, Canada.
FAU - David, Elizabeth
AU  - David E
AD  - Interventional Radiology Department, Sunnybrook Health Sciences Centre, Toronto, 
      Ontario, Canada.
LA  - eng
PT  - Journal Article
DEP - 20210927
PL  - United States
TA  - Can Assoc Radiol J
JT  - Canadian Association of Radiologists journal = Journal l'Association canadienne 
      des radiologistes
JID - 8812910
SB  - IM
MH  - Adult
MH  - *Catheterization, Central Venous/adverse effects
MH  - Catheters, Indwelling/adverse effects
MH  - *Central Venous Catheters
MH  - Humans
MH  - Obesity
MH  - Renal Dialysis/adverse effects
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - cuff
OT  - hemodialysis
OT  - risk factor
OT  - tunneled catheter
EDAT- 2021/09/29 06:00
MHDA- 2022/04/23 06:00
CRDT- 2021/09/28 05:28
PHST- 2021/09/29 06:00 [pubmed]
PHST- 2022/04/23 06:00 [medline]
PHST- 2021/09/28 05:28 [entrez]
AID - 10.1177/08465371211041241 [doi]
PST - ppublish
SO  - Can Assoc Radiol J. 2022 May;73(2):410-418. doi: 10.1177/08465371211041241. Epub 
      2021 Sep 27.