Ep. 3 Tunneled Dialysis Catheters with Dr. Peter Bream and Dr. Aaron Brandis
May 24, 2017
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Dr. Peter Bream and Dr. Aaron Brandis discuss the pros and cons of antegrade versus retrograde tunneled dialysis catheter placement. They emphasize the importance of consistent tip location, hygiene, and preventing infections. They explore the impact of patient factors on catheter success and discuss the effectiveness of coatings in reducing infection rates. Optimizing catheter placement is highlighted to reduce reliance on catheters for dialysis.
Retrograde placement of catheters for dialysis allows for accurate positioning and reduces the risk of complications and the need for additional adjustments.
Symmetrical tip catheters, like the Vector Flow catheter, offer easier positioning, optimal flow rates, and improved performance.
Deep dives
Advantages of Retrograde Placement of Catheters
Dr. Peter Brem discusses the advantages of retrograde placement of catheters for dialysis. He explains that a consistent tip location is crucial for optimum performance, and by placing the tip first and then creating the tunnel, the catheter can be positioned accurately without the need for additional adjustments. This approach reduces the risk of complications and allows for easy removal and replacement if needed. Dr. Brem also highlights the benefits of using a dilator from Cook called the coke transitional dilator, which simplifies the process and provides better control during placement.
Symmetrical Tip Catheters and Their Advantages
Dr. Aaron Brandes and Dr. Peter Brem discuss symmetrical tip catheters and their advantages over split tip catheters. They explain that symmetrical tip catheters, such as the vector flow catheter, allow for easier positioning and alignment, resulting in optimal flow rates. They emphasize the importance of placing the catheter tip correctly in the mid-right atrium to ensure good flows. Dr. Brandes particularly highlights the benefits of the vector flow catheter, which uses helical flow at the tip to minimize recirculation, reduce platelet aggregation, and improve overall performance.
The Role of Patient Factors and Hygiene in Catheter Performance
Dr. Peter Brem and Dr. Aaron Brandes emphasize the importance of patient factors and proper hygiene in catheter performance. They explain that while certain catheter coatings, like silver ion antimicrobial coatings, may offer some benefits, they believe that these coatings alone cannot overcome patient-specific factors that contribute to catheter-related complications. They stress the need for a holistic approach that includes maintaining good hygiene practices and working collectively with dialysis centers and nephrologists to reduce infection rates and promote successful dialysis outcomes.