Central Vein Stenosis Due to Dialysis Catheter Insertion in Subclavian Compared to Jugular Vein

NCT ID: NCT04871568

Last Updated: 2024-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-15

Study Completion Date

2025-12-31

Brief Summary

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Central vein stenosis (CVS) is a well-known complication of central venous catheterization, especially after insertion of temporary hemodialysis catheters (tHDC). Incidence and prevalence differ between studies, and exact figures are hard to tell since proper venographies seldom are performed unless the patient is symptomatic.

Most tHDC are placed in the jugular or femoral veins as catheters in the subclavian veins have been shown to result in CVS to a greater degree. However, some studies are equivocal and there are several advantages with the subclavian vein such as a lower risk for infectious and thrombotic complications, longer durability (thereby avoiding placement of a new catheter with repeated tissue trauma), increased comfort during insertion and use, less effect on blood flow if the patient moves the head, easier to mobilize.

The studies on CVS incidence originate from the 1990s when ultrasound-guided insertions were unheard of and polyurethane catheters were prevalent. The investigators believe that there is less tissue trauma when using ultrasound guidance in real-time. Furthermore, CVS is less common when silicone catheters are used instead of polyurethane catheters.

To avoid unnecessary vascular trauma and patient suffering, any pre-existing CVS should ideally be detected before cannulation attempts. A CT scan of the chest with IV contrast is preferred, but this exposes the patient to ionized radiation, is time-consuming and (although debated) may cause contrast-induced nephropathy. A brief ultrasound examination to verify central venous patency would be useful provided it is shown to have an adequate sensitivity for stenosis detection.

Detailed Description

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This is a multicentric, prospective, randomized, controlled, assessor-blinded, non-inferiority trial. Patients will be enrolled in three hospitals (Lund, Malmö, Helsingborg) in southern Sweden. The trial is investigator-initiated and non-commercial. The radiologist interpreting CT venographies will be blinded to study group allocation, whereas the patient, the treating physicians and other care providers will not be blinded.

Patients will be randomized to receive a silicone tCDC either in the right subclavian vein (intervention) or in the right internal jugular vein (control). All catheterizations will be performed in a standardized manner. A questionnaire regarding the patient's experience of the catheterization procedure is handed out as soon as possible, preferably immediately after catheterization if the clinical situation permits.

Follow-up is carried out 3-6 months after the removal of the catheter to eliminate transitory thrombosis. A CT venography with a customized protocol for this study will be performed to look for CVS. An ultrasound examination of the central veins is performed and compared to the findings of the CT venography.

Conditions

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Subclavian Vein Stenosis Jugular Vein Occlusion

Keywords

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Central Venous Stenosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Right subclavian vein catheterization

The temporary central dialysis catheter is placed in the right subclavian vein.

Group Type ACTIVE_COMPARATOR

Temporary central dialysis catheterization

Intervention Type PROCEDURE

Placement of temporary central dialysis catheter

Right internal jugular vein catheterization

The temporary central dialysis catheter is placed in the right internal jugular vein.

Group Type ACTIVE_COMPARATOR

Temporary central dialysis catheterization

Intervention Type PROCEDURE

Placement of temporary central dialysis catheter

Interventions

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Temporary central dialysis catheterization

Placement of temporary central dialysis catheter

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adults (18 years of age or older).
* In need of a tCDC with an expected treatment time of at least 7 days.
* Informed consent.

Exclusion Criteria

* Intravenous pacemaker or a PICC-line via right-sided central veins in situ.
* Known right-sided CVS.
* AV fistula on the right upper extremity.
* History of central venous vascular interventions including stents, dilatations and more (but not previous central venous catheterization).
* Central venous catheter in the right internal jugular vein or in the right subclavian vein in situ.
* Either the right jugular vein or the right subclavian vein unavailable for catheterization due to, e.g., local skin infection, thrombosis or inability to visualize the vein with ultrasound.
* Known allergy to iodinated contrast agents.
* BMI \>35 kg/m2.
* No study physician available for the catheterization.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Skane University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ola Borgquist

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ola Borgquist, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Skånes universitetssjukhus

Thomas Kander, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Skånes universitetssjukhus

Locations

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Skånes universitetssjukhus

Lund, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Ola Borgquist, MD, PhD

Role: CONTACT

Phone: +46704156334

Email: [email protected]

Thomas Kander, MD, PhD

Role: CONTACT

Email: [email protected]

Facility Contacts

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Ola Borgquist, MD, PhD

Role: primary

Thomas Kander, MD, PhD

Role: backup

References

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Borgquist O, Naddi L, Bozovic G, Hellberg M, Annborn M, Sjovall F, Adrian M, Hettinger E, Sjoberg P, Kander T. Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter: study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial. Trials. 2023 May 12;24(1):327. doi: 10.1186/s13063-023-07350-9.

Reference Type DERIVED
PMID: 37173715 (View on PubMed)

Other Identifiers

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CDC stenosis

Identifier Type: -

Identifier Source: org_study_id