Effectiveness of double lumen CVC with extra port in preventing multiple CVC insertions in critically ill patients

摘要

Critically ill shock patients presenting to the Emergency Department (ED) in Hamad General Hospital (HGH), Doha Qatar often needs central line when fluid resuscitation fails to improve their blood pressure (BP). Triple lumen central lines are used when vasopressor or inotropic support becomes necessary. In some of these patients, a double lumen dialysis line is later inserted (often in the femoral vein), when it becomes clearer that the patient will need urgent dialysis for worsening renal function or acid-base physiology. Another clinical scenario we often encounter is when patient admitted to the ED for emergency dialysis session. Some of these patients have borderline to low BP that become obvious during the dialysis, eventually needing some vasopressor support to enable the dialysis session to be continued. More than 2 years ago we introduced the use of dialysis line with extra port (Trilyse Expert by Vygon) in the Intensive Care Unit and now its use has spread to front line ED resuscitation room. Indications for Trilyse Expert insertion are: 1. Patients who needed vasopressor or inotropic support who may need dialysis, 2. Patients who needed dialysis with borderline to low BP who may need vasopressor support during dialysis, 3. Patients who needed both dialysis and vasopressor/inotropic support on presentation to ED. In this retrospective cohort we looked into the effectiveness of Trilyse Expert inserted in our ED resuscitation room in preventing the need of a second central line insertion. We also reviewed all relevant complications related to the device and its insertion. We also conducted a systematic literature review in the use of dialysis line with extra port in critically ill patients to support our findings. Results is shown in charts and tables. Concluding better outcome when using double lumen CVC with extra port.