the EMCrit Crew

We are EMCrit. We explore an obsession with Critical Care and Resuscitation. Editor in Chief: Scott Weingart

[the EMCrit Crew @emcrit]

EMCrit 437 - Massive Lithium Overdose with @NephroTox (tox + nephro in one human):
-Gastric Decon
-Who to dialyze
-Why nephrologists are vampires
and so much more!
[#FOAMed for now}
https://t.co/hu5QAfraHy

[the EMCrit Crew @emcrit]

EMCrit Wee - Pre- PRECARE - Prehospital ECPR with Nat & Bri from Sydney HEMS
[#FOAMed for now]
https://t.co/s0w0SX7PhZ

[the EMCrit Crew @emcrit]

@PARALIFELINE this is AI and it is really bad

[the EMCrit Crew @emcrit]

EMCrit 436 - When you RSI Shocked Patients, they Tend to Die

8 years later, we are bringing HNI out of the expert-only realm so anyone can intubate shocky patients safely without causing post-intubation arrest & hopefully not causing any BP/CO drop at all...

[#FOAMed for Now]

https://t.co/g77f08EmHD

[the EMCrit Crew @emcrit]

One of my ex-fellows and I published a case report and discussion of Hemodynamically Neutral Intubation on a massive PE patient:

https://t.co/RXLOf7jpKb

[the EMCrit Crew @emcrit]

In 5 minutes (19:30 ET), I am doing a free EMS resus Q&A sponsored by Nassau University--feel free to join if you are around EMScritters

https://t.co/J79itL2C2K

[the EMCrit Crew @emcrit]

EMCrit Explosion Wee - F/u with the 2026 ACEP Sedation Guidelines Authors -- A follow-up episode on the @ACEP sedation guidelines.

[#FOAMed for Now]
https://t.co/jpAWgJZc5X

[the EMCrit Crew @emcrit]

EMCrit 435 – Procedural Sedation Part VI:
I break down the new ACEP unscheduled procedural sedation guidelines, call out the absurd pretense surrounding 'deep sedation', and lay out where emergency sedation needs to go in 2026.

https://t.co/sWFvXuIl0f

[the EMCrit Crew @emcrit]

@rmohty excellent!! all added to shownotes

[the EMCrit Crew @emcrit]

We have data on the 393 of the patients who had their catheters cultured on removal.

In those patients, the TLCs (triple lumen caths) were used a mean of 4.3 times over the entire duration of the catheter. Some of those TLCs were not used at all outside of RRT.

This is not quite what we think of when we see a trial of TLC vs. DLC dialysis caths. Our expectation is that use would reflect the real world: These lines are being accessed all the time if you're putting in the TLC specifically to act as a substitute for a secondarily placed central line.

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[the EMCrit Crew @emcrit]

In conclusion, thank you for the RCT. Please be nicer if you can. I'm still not sure whether these devices are a free ride or not. I welcome your comments, and I will put on my asbestos suit.

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[the EMCrit Crew @emcrit]

Now, seemingly, what you objected to in the show notes of my post: I'm pretty sure you didn't listen to the actual podcast, because I bent over backwards to say that "I'd love to see more literature on these triple-lumen dialysis catheters. I can make no firm conclusions about infection rate or flow rates," but in the show notes, I think the words "potentially may increase infections" may have sent you to actually reply to my post.

My very lukewarm contention was predicated on the Truveta data (DOI: 10.1177/11297298251352470), which did indeed show an increased infection rate with the triple-lumen catheters. Now, this study is retrospective. It is a database survey. It is by no means strong evidence, and, like I said, I did not have this RCT to evaluate.

That being said, the increased relative risk of infection in that trial, with the incredibly confounded results of the RCT you posted would still leave me standing by: potentially, there is an increased infection rate. I don't think that is a myth. I don't think it's been debunked. I certainly think your RCT is helpful in making us feel a little bit better, but this is, in my mind, still an unanswered question as to whether these triple-lumen catheters are as safe as a dual-lumen catheter that you don't touch.

We also anecdotally have a bunch of experience that the flow rates on these devices are not as good, though the data I have seen has not borne this out.

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[the EMCrit Crew @emcrit]

However, some peculiarities do emerge upon further examination:
The TLCs were in median of 5 days. Not much time for infection, but still not a big issue.

but then something weird does emerge when we look at interprocedural use (i.e. using the line for anything except during RRT, like blood draws, med administration, etc.)

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[the EMCrit Crew @emcrit]

First off, thanks so much for sending this citation. I was looking for RCTs, and it didn't come up in my search!

Now I'm going to address the medicine in just a minute, but first, I just wonder: if you came up to me at a conference, having seen my post, would you say to me, "Sad to see the perpetuated myth of dialysis cons of higher potential infection?"

Doesn't seem to be the most collegial way to interact. Is this an example of the "online disinhibition effect," Or is this how you interact with people in general?

It's only my opinion, but maybe, "hey Scott, did you see this RCT," or "did you know they did an RCT on this?" would engender a little bit more of a warm interaction if that's what you were going for?

ok, on to the study...

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[the EMCrit Crew @emcrit]

So this was a manufacturer-sponsored pre-clearance RCT. Doesn't discount it just based on that, but it does make one look slightly askance at the results. But that wouldn't be a problem in and of itself....

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[the EMCrit Crew @emcrit]

@emcrit Sad to see the perpetuated myth of the trialysis cons of higher potential infection... This has never been proven, and in fact evidence suggests otherwise

https://t.co/sUvgbfaGmh

[the EMCrit Crew @emcrit]

EMCrit 434: Temporary Hemodialysis Catheters

Delays Are to the Patient's Detriment! We cover catheter sizing, site selection, the two jumps of dilation microskills, pre-dilation vascular confirmation, and so much more!
https://t.co/gV8Pgwqxjr

[the EMCrit Crew @emcrit]

EMCrit RACC Lit Review - September 2026

- Ditch the X-ray for NG tube placement with end-tidal CO2?
-Why you need to get tourniquets off ASAP,
-Partial REBOA
-Cold-stored platelets & more
https://t.co/YpQV871Nc9