Comparison of High-Flow Hemodialysis Catheters Placed From the Left Internal Jugular Vein(R12-022)

Study Overview
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Brief Summary
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The patient population for this study is individuals requiring high-flow polyurethane tunneled dialysis catheters (TDC) for hemodialysis access. The primary objective of this study is to compare outcomes of participants who undergo left internal jugular placement of a split-tip versus a step-tip versus symmetric tip catheter. This study will review and compare the complication rate and function of the three catheter designs.

Detailed Description
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The patient population for this study is individuals requiring high-flow polyurethane tunneled dialysis catheters (TDC) for hemodialysis access. The primary objective of this study is to compare outcomes of participants who undergo left internal jugular placement of a split-tip versus a step-tip versus symmetric tip catheter. Participants will be randomized to receive a split-tip, step-tip or symmetric tip catheter in a 1:1:1 ratio. All participants will be followed per their referring physician's standard of care. Information regarding any patient complications will be obtained from Dr. Allon's dialysis patient database (Vascular Access in Hemodialysis Patients, IRB # X980813005). This study will review and compare the complication rate and function of the three catheter designs. There are no studies to our knowledge that compared catheter designs placed specifically via the left internal jugular vein. The investigators hypothesize that because the left internal jugular vein is anatomically more complex than the right one, tunneled dialysis catheters with split-tip design may perform sub-optimally, compared to step-tip and symmetric tip designs, when placed via the left internal jugular vein. If this hypothesis is true, the results of the study may influence future clinical practice and reduce the rates of replacement of catheters placed through the left internal jugular vein, resulting in better patient care and significant cost-savings.

Official Title
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High-Flow Hemodialysis Catheters Placed Through the Left Internal Jugular Approach (R12-022)

Conditions
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End Stage Renal Disease on Dialysis (Diagnosis)

Intervention / Treatment
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* Device: Tunneled dialysis catheter placement.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willing and able to provide a written informed consent 19 years or older Hemodialysis patient needing high-flow polyurethane tunneled dialysis catheter placement via the left internal jugular vein. Patent left internal jugular vein. Able to read and understand English. Exclusion Criteria: Previous enrollment in this trial Patients unable or unwilling to provide informed consent Prisoners or incarcerated individuals Women who are pregnant Patients in whom the left internal jugular vein is occluded or catheter placement is otherwise contraindicated

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Device Feasibility
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Tunneled dialysis Split-tip catheter<br>High-flow tunneled Split-tip catheter for hemodialysis will be inserted by standard interventional technique | Device: Tunneled dialysis catheter placement.<br>* Placement of high-flow tunneled catheter for hemodialysis<br>|
| Active Comparator: Tunneled dialysis Step-tip catheter<br>High-flow tunneled Step-tip catheter for hemodialysis will be inserted by standard interventional technique | Device: Tunneled dialysis catheter placement.<br>* Placement of high-flow tunneled catheter for hemodialysis<br>|
| Active Comparator: Tunneled dialysis Symmetric tip catheter<br>High-flow tunneled Symmetric tip catheter for hemodialysis will be inserted by standard interventional technique | Device: Tunneled dialysis catheter placement.<br>* Placement of high-flow tunneled catheter for hemodialysis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complication rate | 1 month complication rate of left internal jugular vein dialysis catheters | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Catheter dysfunction | 1 month complication rate of left internal jugular vein dialysis catheters | 1 months | 
| Catheter dysfunction | 3 months complication rate of left internal jugular vein dialysis catheters | 3 months | 
| Catheter dysfunction | 6 months complication rate of left internal jugular vein dialysis catheters | 6 months | 
| Complication rate | 3 months complication rate of left internal jugular vein dialysis catheters | 3 months | 
| Complication rate | 6 months complication rate of left internal jugular vein dialysis catheters | 6 months |