Pistoning in continuous renal extracorporeal replacement therapy catheters: Longitudinal descriptive study

Area of Science:

• Nephrology
• Critical Care Medicine
• Vascular Access

Background:

• Pistoning, defined as catheter movement at the insertion site, is a potential complication in vascular access devices.
• Understanding pistoning in continuous renal replacement therapy catheters (CRRTC) is crucial for patient safety and treatment efficacy.

Purpose of the Study:

• To investigate the incidence of pistoning in CRRT catheters.
• To explore the association between pistoning, intravascular thrombosis, and catheter dysfunction.

Main Methods:

• A longitudinal descriptive study was conducted in two ICUs from March 2023 to June 2024.
• Data collected included patient BMI, catheter dwell time, insertion site, and assessed for pistoning, dysfunction, and suture fixation status (SFS).
• Post-removal ultrasound evaluated for intravascular thrombosis.

Main Results:

• Pistoning was observed in 42.9% of CRRT catheters, with dysfunction in 31.8%.
• Incorrect SFS was significantly associated with pistoning (59.3% vs. 11.1%, p < 0.001).
• Catheters with pistoning had longer dwell times (11 days vs. 7.3 days, p = 0.02), and dysfunction was more frequent in obese patients (BMI 34.5 vs. 29.8 kg/m², p = 0.03).

Conclusions:

• Pistoning is a frequent complication of CRRT catheters, primarily linked to inadequate suture fixation and prolonged dwell times.
• Catheter dysfunction shows a higher prevalence in patients with obesity.
• These findings highlight the importance of proper catheter fixation techniques and monitoring in CRRT patients.