The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
BACKGROUND: Some nephrologists remove tunneled hemodialysis catheters (TDC) at the bedside, but this practice has never been formally studied. Our hypothesis was that bedside removal of TDC is a safe and effective procedure affording prompt removal, including in cases of suspected infection. METHODS: We reviewed our consecutive 3-year experience (2007-2009) with bedside TDC removal at the University of Mississippi Renal Fellowship Program. Data were collected on multiple patients and procedure-related variables, success and complication rates. Association between clinical characteristics and biomarkers of inflammation and myocardial damage was examined using correlation coefficients. RESULTS: Of 55 inpatient TDC removals (90.9% from internal jugular location), 50 (90.9%) were completed without hands-on assistance from faculty. Indications at the time of removal included bacteremia, fever or clinical sepsis with hemodynamic instability or respiratory failure. All procedures were successful, with no cuff retention noted; one patient experienced prolonged bleeding which was controlled with local pressure. Peak C-reactive protein (available in 63.6% of cohort) was 12.9 ± 8.4 mg/dL (reference range: <0.49) and median troponin-I (34% available) was 0.534 ng/mL (IQR 0.03-0.9) (reference range: <0.034) and they did not correlate with each other. Abnormal troponin-I was associated with proven bacteremia (p < 0.05) but not with systolic and diastolic BP or clinical sepsis. CONCLUSION: Our results suggest that bedside removal of TDC remains a safe and effective procedure regardless of site or indications. Accordingly, TDC removal should be an integral part of competent Nephrology training.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it