Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia.
Am J Kidney Dis. 2012 Aug;60(2):272-9. doi: 10.1053/j.ajkd.2012.01.021. Epub 2012 Apr 11.
The aim was to assess whether inserting a longer soft silicone short-term dialysis catheter targeting tip placement in the right atrium could improve dialyzer circuit life span compared with inserting a shorter dialysis catheter targeting tip placement in the superior vena cava.
Randomized unblinded controlled study.
SETTING & PARTICIPANTS: A tertiary multidisciplinary intensive care unit enrolling 100 critically ill patients requiring continuous renal replacement therapy (CRRT).
Placement of longer (20-24 cm) versus shorter dialysis catheters (15-20 cm) within one of the major thoracic veins for initiation of CRRT.
The primary study outcome was duration of dialysis circuit life span. Secondary outcomes included delivered daily dialysis dose, incidence and cause of CRRT circuit failure, complications potentially related to the position of the short-term dialysis catheter, mortality, and patient length of stay.
Placing the longer dialysis catheters was associated with an increased average dialyzer life span of 6.5 hours (24 hours [25th-75th percentile, 11-32] vs 17.5 hours [25th-75th percentile, 8-23]; P = 0.001), improved delivered daily dialysis dose (91% [25th-75th percentile, 85%-100%] vs 81% [25th-75th percentile, 72%-97%]; P < 0.001), and reduced number of dialyzers clotted (2.3 vs 3.6; P = 0.04) or circuits taken down due to vascular access problem (0.19 vs 0.53; P = 0.04) per patient compared with placing shorter dialysis catheters. The incidence of atrial arrhythmias was similar between groups (28% vs 21%; P = 0.6) and the only mechanical complication was the malposition of one dialysis catheter tip in the longer dialysis catheter group.
Single-center study design.
The use of longer soft silicone short-term dialysis catheters targeting right atrial placement appeared to be safe and could improve dialyzer life span and daily dialysis dose of CRRT delivered compared with the use of shorter catheters targeting superior vena cava placement.
本研究旨在评估将目标尖端置于右心房的较长软硅胶短期透析导管与将目标尖端置于上腔静脉的较短透析导管相比，是否能延长透析器回路的使用寿命。
随机非盲对照研究。
一家三级多学科重症监护病房，纳入 100 名需要连续肾脏替代治疗（CRRT）的危重症患者。
在主要胸静脉之一内放置较长（20-24cm）和较短（15-20cm）的透析导管，以启动 CRRT。
透析器回路寿命的主要研究结局。次要结局包括每日透析剂量、CRRT 回路故障的发生率和原因、与短期透析导管位置相关的并发症、死亡率和患者住院时间。
放置较长的透析导管与平均透析器寿命延长 6.5 小时相关（24 小时[25 百分位-75 百分位，11-32]与 17.5 小时[25 百分位-75 百分位，8-23]；P=0.001），每日透析剂量改善（91%[25 百分位-75 百分位，85%-100%]与 81%[25 百分位-75 百分位，72%-97%]；P<0.001），每个患者因血管通路问题导致的透析器凝块（2.3 与 3.6；P=0.04）或因血管通路问题导致的回路关闭（0.19 与 0.53；P=0.04）的数量减少。两组心房纤颤的发生率相似（28%与 21%；P=0.6），唯一的机械并发症是较长透析导管组的一个透析导管尖端位置不当。
单中心研究设计。
与使用上腔静脉置管的较短透析导管相比，使用目标尖端位于右心房的较长软硅胶短期透析导管似乎是安全的，并且可以延长透析器的使用寿命和 CRRT 的每日透析剂量。
