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. 4 of 8

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. 7 of 8

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... 1 of 8

EMCrit 429 - RUSH 2.0 - The I-RUSH and CRUSH Exams Finally dropping the RUSH Exam 2.0 on this week's EMCrit Podcast! We're moving past just the crashing patient to bring you the Interface-Informed RUSH. Get ready to standardize your hemodynamic assessments at the bedside. [#FOAMed] emcrit.org/429