Prevalence of catheter related central vein stenosis in hemodialysis patients (two centers study)

BACKGROUND: Central vein stenosis (CVS) is a common complication of central venous catheter (CVC) insertion. Placement of a central vein catheter for dialysis access substantially increases the risk of CVS. OBJECTIVE: to determine the prevalence of catheter related CVS in hemodialysis (HD) patients and its relation to duration of chronic kidney disease(CKD), catheter site, dwell time insertion, number of catheters, time from catheter removal, catheter infection and Acetyl salicylic acid (ASA) use. METHODS: This included 200 haemodialysis patients from those attending to the dialysis units in Zagazig university hospitals & in health insurance hospital (Elmabarra) with previous history of at least one central vein catheter insertion for HD in the period between May 2013 to August 2014.The patients were divided into 2 groups according to doppler ultrasound results: Group A (with venous stenosis) : It included 64 patients (36 males and 28 females) with age range (17 to 74 years) with X±SD of 40.7±13.9 years and Group B (without venous stenosis): It included 136 patients (74 males and 62 females) with age range (18 to 75 years) with X±SD of 42.2±14.2 years. Also both groups were classified as regard to duration of CKD, catheter site, dwell time insertion, number of catheters, time from catheter removal, catheter infection and ASA use. All patients were enrolled after written informed consent. RESULTS: We found a prevalence of 32% of stenosis following catheterization of central vein in our study patients. We could not find any difference between the patients with and without stenosis regarding age, sex and duration of CKD, however, there was a significant difference in prevalence of stenosis regarding the type of central vein of 20% in subclavian vein and 12% in internal jugular vein, (p<0.05). We found a statistically significant increase in CVS regarding dwell time of catheter insertion, number of catheters insertion in one site, frequency of catheter infection and time from catheter removal when comparing both groups of patients. Regarding the role of ASA use in minimizing the occurrence of CVS, we found a statistically significant increase of CVS with less use of ASA when comparing both groups. CONCLUSIONS: CVS is not a rare problem in patients on hemodialysis in the two units of the study; infection, repeated cannulation, subclavian vein more than internal jagular vein type and prolonged dwell time of catheter insertion are risk factors for development of CVS and administration of ASA in low dose seems to lessen the occurrence of CVS.