Kidney Week

Abstract: SA-PO186

Hemodialysis Central Venous Catheter Placement by Nephrology Fellows

Session Information

• Educational Research
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

• 800 Educational Research

Authors

• Arellano-Mendez, Denisse, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Denisse Arellano-Mendez,

• Soto-Vargas, Javier, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Javier Soto-Vargas,

• Gutierrez-Prieto, Julio Alejandro, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Julio Alejandro Gutierrez-Prieto,

• Hernandez Gonzalez, Godhy Eli, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Godhy Eli Hernandez Gonzalez,

• Delgado-Ayon, Omar Ignacio, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Omar Ignacio Delgado-Ayon,

• Jiménez Mejía, Carlos Daniel, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Carlos Daniel Jiménez Mejía,

• Pazarin-Villaseñor, Leonardo, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Leonardo Pazarin-Villaseñor,

• Salazar Lopez, Ma Anabel, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Ma Anabel Salazar Lopez,

• García Cárdenas, Mario Alberto, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Mario Alberto García Cárdenas,

• Parra Michel, Renato, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional No 46 del IMSS, Guadalajara, Mexico

Renato Parra Michel,

Background

There is no evidence about the number of central venous catheter (CVC) procedures required for a nephrology fellow to acquire competency, besides, these procedures are now being perform by other specialties, moving those away from the basic training of a nephrology program. Nevertheless, in low and middle-income countries, the nephrologist has a key role in CVC placement. Our main objective is to present the experience in CVC placement in a nephrology fellowship program.

Methods

During March 2017 to February 2018, six first-year nephrology fellows performed 362 procedures. We collected information about number of catheter placed by every fellow, technique (anatomic landmarks or ultrasound guidance [USG]), if it was urgent, vascular region, number, and type of complications. Then we analyzed factors related to occurrence of complications in a multivariate model adjusted for vascular region, urgency of the procedure, use of USG and the time since the beginning of the study year.

Results

The median number of procedures was 60 (range 31-90) per fellow. The overall success rate was 95.3%, with 98 (27.1%) minor and no major complications. The more prevalent complications were bleeding (40, 11%), hematoma formation (15, 4.1%), >3 punctures (25, 6.9%), and arterial punctures (17, 4.7%). In the logistic regression model, the use of USG had a trend toward to a significant association for complications (OR 0.62, CI 95% 0.38-1.00, P =0.05), while in a Cox regression the use of USG reached significance with a 48% risk reduction for complications (HR 0.52 CI 95% 0.33-0.80, P <0.01).
USG use increased after 90 days of training; therefore, we analyzed the association of USG to complications considering time as a covariate. Before 90 days the presence of complications was independent to USG usage (HR 0.81 CI 95% 0.47-1.41, P=0.47), and after 90 days there were a higher risk reduction (HR 0.23 CI 95% 0.11-0.5, P <0.01).

Conclusion

The CVC placement by nephrology fellows is safe and successful; it should be part of nephrologist formation and include training on USG to reduce the risk for complications.