Kang Seok Hui, Do Jun Young
Division of Nephrology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Yeungnam Univ J Med. 2020 Jul;37(3):186-193. doi: 10.12701/yujm.2019.00465. Epub 2020 Mar 17.
Non-tunneled catheters (NTCs) are used for hemodialysis (HD) in many centers in which fluoroscopy is not easily accessed despite high complication rates and conditions requiring long-term HD. Therefore, here we aimed to evaluate the superiority of catheter-related outcomes after the application of tunneled cuffed catheter (TCC) without fluoroscopy versus unconditioned NTC insertion.
We divided the participants into two phases: those receiving NTCs between March 2010 and February 2011 (phase I), and those receiving TCCs or NTCs between March 2011 and February 2012 (phase II). Catheter survival, nurse satisfaction, and reasons for catheter removal were analyzed.
Two hundred and sixty patients in phase I and 300 patients in phase II were enrolled in this study. The success rate of TCC insertion was 99.2%. The catheter survival rate in phase I was 65.5% at 1 month, while that in phase II was 74.9% at 1 month (p=0.023). We compared catheter survival between TCCs and NTCs for all periods regardless of phase. The TCC survival rate was higher than the NTC survival rate (p<0.001). Catheter-associated problems led to catheter removal in 97 patients (26.6%) in phase I and 68 patients (18.5%) in phase II (p=0.009). Among 14 HD nurses, all reported being satisfied with manipulation during pre-/post-HD, manupulation during HD, and overall. Eleven HD nurses (78.6%) reported being satisfied with the workload.
Compared with unconditional NTC insertion for HD, TCC insertion without fluoroscopy improved the overall catheter survival and nurse satisfaction rates.
在许多不易进行荧光透视检查的中心，尽管非隧道式导管（NTC）并发症发生率高且适用于长期血液透析（HD）的情况，但仍被用于血液透析。因此，我们旨在评估在不使用荧光透视的情况下应用带隧道带 cuff 的导管（TCC）与无条件插入 NTC 相比，导管相关结果的优越性。
我们将参与者分为两个阶段：2010 年 3 月至 2011 年 2 月期间接受 NTC 的患者（第一阶段），以及 2011 年 3 月至 2012 年 2 月期间接受 TCC 或 NTC 的患者（第二阶段）。分析导管生存率、护士满意度以及导管拔除原因。
本研究纳入了第一阶段的 260 名患者和第二阶段的 300 名患者。TCC 插入成功率为 99.2%。第一阶段 1 个月时导管生存率为 65.5%，而第二阶段 1 个月时为 74.9%（p = 0.023）。我们比较了所有时期 TCC 和 NTC 之间的导管生存率，无论处于哪个阶段。TCC 生存率高于 NTC 生存率（p < 0.001）。导管相关问题导致第一阶段 97 名患者（26.6%）和第二阶段 68 名患者（18.5%）的导管被拔除（p = 0.009）。在 14 名血液透析护士中，所有人都报告对透析前/后操作、透析期间操作以及总体情况感到满意。11 名血液透析护士（78.6%）报告对工作量感到满意。
与无条件插入 NTC 进行血液透析相比,不使用荧光透视插入 TCC 提高了总体导管生存率和护士满意度。
