Clinical and Technical Factors Associated With Tunnelled Central Venous Catheter Dysfunction in Haemodialysis: A...

To analyse the clinical, technical, and demographic factors associated with tunnelled central venous catheter dysfunction in patients undergoing haemodialysis.

Multicentre, retrospective session-level observational study.

We analysed 40,193 haemodialysis sessions from 743 patients with tunnelled central venous catheters. Descriptive and univariate analyses were performed to explore associations between catheter dysfunction and clinical, technical and treatment-related variables. Dysfunction within a session was defined by a blood flow < 300 mL/min together with abnormal arterial (< -250 mmHg) or venous (> +250 mmHg) pressures at baseline or 60 min.

Nefrosoft clinical system (January-December 2021).

As expected from the operational definition, sessions classified as dysfunctional showed lower blood flow and more extreme arterial and venous pressures. Beyond the intradialytic markers included in the operational definition, dysfunctional sessions more frequently involved management-related measures such as catheter line reversal and the use of 5% heparin locks, as well as catheter placement in the left internal jugular vein and comorbidities such as diabetes and cardiovascular disease. Because line reversal and 5% heparin locks may represent responses to poor catheter performance, these findings should be interpreted cautiously. Sessions with dysfunction also showed lower dialysis efficacy, particularly in male patients. Overall systemic anticoagulant therapy was more frequent in sessions with dysfunction, whereas overall systemic antiplatelet therapy, analysed as a binary variable, was not significantly associated with the event.

Catheter dysfunction is a frequent complication with multifactorial associations. Our findings highlight the importance of systematic clinical and technical monitoring during haemodialysis sessions. Associations identified here are descriptive and hypothesis-generating; further studies with adjusted analyses are needed before conclusions about prediction or causality can be drawn.