Department of Intensive Care Medicine, Austin Hospital, Melbourne, VIC, Australia.
Ren Fail. 2013;35(3):308-13. doi: 10.3109/0886022X.2012.757823. Epub 2013 Jan 29.
The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT). In particular, differences in catheter design might affect the incidence of circuit clotting related to catheter malfunction.
Sequential controlled study in a tertiary, adult intensive care unit (ICU).
To compare circuit life when CRRT was performed with a Niagara catheter or a Medcomp catheter.
We studied 46 patients with acute kidney injury requiring CRRT, all delivered with catheters in the femoral position. We obtained information on age, gender, disease severity score [acute physiology and chronic health evaluation (APACHE II) and APACHE III], filter life, heparin dose per hour, daily systemic hemoglobin concentration, platelet count, international normalized ratio (INR), and activated partial thromboplastin time (APTT) during CRRT.
We studied 254 circuits in 46 patients. Of these, 26 patients (140 circuits) used the Niagara catheter and 20 patients (114 circuits) used the Medcomp catheter. Median circuit life in the two groups were 11 h and 7.3 h, respectively (p < 0.01). Patients using Medcomp catheters had a lower platelet count (p = 0.04) and a lower hemoglobin concentration (p = 0.01), but INR (p = 0.16), APTT (p = 0.46), anticoagulant treatment (p = 0.89), and heparin dose per hour (p = 0.24) were similar. After correcting for confounding variables by multivariable linear regression analysis, it was found that the choice of catheter is not an independent predictor of circuit life. On Kaplan-Meier survival analysis, circuit life was not significantly different between the two catheters (p = 0.87).
The choice of either the Niagara or Medcomp catheter does not appear to be a significant independent determinant of circuit life during CRRT.
血管通路导管的选择可能会影响连续性肾脏替代治疗（CRRT）期间的滤器寿命。特别是，导管设计的差异可能会影响与导管功能障碍相关的回路凝血的发生率。
在三级成人重症监护病房（ICU）中进行的序贯对照研究。
比较使用 Niagara 导管或 Medcomp 导管进行 CRRT 时的回路寿命。
我们研究了 46 名需要 CRRT 的急性肾损伤患者，所有患者均在股部位置放置导管。我们获得了有关年龄、性别、疾病严重程度评分[急性生理学和慢性健康评估（APACHE）II 和 APACHE III]、滤器寿命、每小时肝素剂量、每日全身血红蛋白浓度、血小板计数、国际标准化比值（INR）和活化部分凝血活酶时间（APTT）的信息。
我们研究了 46 名患者的 254 个回路。其中，26 名患者（140 个回路）使用 Niagara 导管，20 名患者（114 个回路）使用 Medcomp 导管。两组的中位回路寿命分别为 11 小时和 7.3 小时（p <0.01）。使用 Medcomp 导管的患者血小板计数较低（p = 0.04），血红蛋白浓度较低（p = 0.01），但 INR（p = 0.16）、APTT（p = 0.46）、抗凝治疗（p = 0.89）和每小时肝素剂量（p = 0.24）相似。通过多变量线性回归分析校正混杂变量后，发现导管的选择不是回路寿命的独立预测因素。在 Kaplan-Meier 生存分析中，两种导管之间的回路寿命没有显著差异（p = 0.87）。
在 CRRT 期间，选择 Niagara 或 Medcomp 导管似乎不是回路寿命的显著独立决定因素。
