Short term complications of vascular access using hemodialysis catheters at Moi Teaching and Referral Hospital in Eldoret, Kenya

Abstract

Background: The need for hemodialysis due to kidney disease is steadily rising. A good vascular access is thus vital to prolong the life of these patients. The internal jugular veins (IJV) and femoral vein (FV) are the recommended sites for vascular access. Catheter insertion and dwell in exposes these patients to mechanical and infectious complications. Advanced age, male gender, low or high BMI and comorbidities like diabetes and hypertension have been linked to occurrence of these complications. Paucity of data exists on the incidence and associated factors for these complications in Sub Saharan Africa. Objectives: To determine the frequency and types of these complications and describe the factors associated with these complications. Methods: This was a prospective cohort study conducted among patients who required hemodialysis catheter insertion and dialysis at MTRH renal unit from December 2017 to November 2018. Consecutive sampling was used to recruit 85 patients. A data collection form was utilized to record socio-demographic characteristics, doctors‘ level of expertise, site of vascular access, observed complication and vital signs. A chest radiograph was done on the patients and an assessment of respiratory function over the first 24 hours. Thereafter, a focused weekly assessment for Exit site infection (ESI) and catheter dysfunction was done prior to and during dialysis. Pus swabs for culture collected were analyzed by semi quantitative method. Categorical variables were summarized as frequencies and percentages, Continous variables were summarized as means and standard deviations. Univariate and multivariate logistic regression models were used to check association of variables with mechanical complications. Results: The mean age was 46.3±17.4 years, 49.4% (42/85) were male and 50.6% (43/85) were female. 72 NTHCs and 13 TDCs were analysed. The most common vascular access site was IJV with 89.4% (76/85) the FV site had 10.6% (9/85). An incidence proportion of 15.3% (13/85) and 4.7% (4/85) for mechanical and ESI complications were recorded respectively. The commonest mechanical complication was difficult cannulation with 8.2% (7/85) followed by catheter dysfunction 2(2.4%) and hematoma with 2(2.4%). 90% (77/85) of catheters were placed by experienced doctors and 95% (81/85) of catheters were inserted as emergency procedures. There was a 96% reduced risk of mechanical complication with IJV compared to FV on multivariate analysis (OR 0.04 (95%CI 0, 0.28) P= 0.001). Age, gender BMI and blood pressure did not show any association with mechanical complications. Conclusion: The most frequent mechanical complications is difficult cannulation. Vascular access site was associated with occurrence of mechanical complications whereas advanced age, male gender, low or high BMI, diabetes and hypertension had no effect. Recommendation: The rate of vascular access complications are acceptably low but further comparative studies with ultrasound guided insertion be done to gain comparative advantage. Consider the vascular access site prior to catheter insertion.