Clinical and Technical Factors Associated With Tunnelled Central Venous Catheter Dysfunction in Haemodialysis: A Multicentre Session-Level Retrospective Study.
Verónica Gimeno Hernán, Carla Perez Ingidua, Ana Belén Rivas Paterna and 5 others
PMID 42712253WHAT IT FOUND
Dysfunction occurred in 2.5% of sessions.
Left internal jugular placement, diabetes, and prior vascular access were linked to dysfunction. Heparin locks and line reversals tracked with dysfunction but likely reflected rescue measures. These findings are hypothesis-generating and do not prove cause.
Key findings
01Among 40,193 sessions, 987 (2.5%) met criteria for catheter dysfunction, which was associated with lower dialysis efficacy (Kt).
02Dysfunctional sessions were more frequently associated with left internal jugular catheter placement and baseline comorbidities including diabetes and peripheral arterial disease.
03Catheter line reversal and 5% sodium heparin locking were associated with dysfunction, but the authors interpret these as management responses to poor performance rather than causes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was univariate and did not adjust for within-patient clustering, meaning multiple sessions from the same patient could inflate statistical significance. Associations between dysfunction and factors like line reversal or heparin locks likely reflect reverse causality, as these are often used to manage existing poor function. The dataset lacked information on insertion technique, operator experience, and catheter tip position, which are known factors in dysfunction. Findings are descriptive and hypothesis-generating; they do not prove that any specific factor causes catheter failure.
Declared interests
The authors report no conflicts of interest and no funding.
The easy way to misread this
Do not assume that using 5% heparin locks or reversing catheter lines causes dysfunction. These interventions are frequently used as rescue measures when poor flow is already suspected, so their association with dysfunction reflects clinical response rather than harm.