title: Randomized comparison of split tip versus step tip high-flow hemodialysis catheters.
abstract: BACKGROUND
  Our purpose was to compare the function and complications of two high-flow polyurethane hemodialysis catheters.
  
  
  METHODS
  This prospective, randomized trial compared the Ash-Split (MedComp) and Opti-Flow (Bard Access Systems) catheters. All patients referred for tunneled hemodialysis catheter placement were offered entry in the study, provided they met inclusion criteria. Catheters were placed by interventional radiologists using ultrasound and fluoroscopic guidance. Procedure time and initial complications were recorded. Effective (QbEff) catheter flow rates and recirculation were studied at baseline, one month, three and six months using ultrasonic dilution (Transonic) at various pump speeds (Qb). Episodes of catheter malfunction and infection were recorded. Catheter removal or six months was the study endpoint.
  
  
  RESULTS
  A total of 132 patients were enrolled in the trial. The groups did not differ as to age, sex distribution, height or weight (P> 0.05). Initial complications included kinking resulting in catheter failure (Optiflow N = 3), and tunnel bleeding (Optiflow N = 1; Ash N = 3). Adjusted mean flow rates (QbEff) at Qb300 were 299 mL/min Ash and 305 mL/min Optiflow (P = 0.06), at Qb400 were 365 mL/min Ash and 382 mL/min Optiflow (P = 0.01), and at QbMax were 414 mL/min Ash and 433 mL/min Optiflow (P = 0.03). Recirculation was significantly higher with the Optiflow catheter at most measurement points. Total late complications were lower in the Ash group (P = 0.04), and catheter survival was significantly higher in the Ash group (P = 0.02).
  
  
  CONCLUSIONS
  Both catheters can deliver flow rates well beyond those recommended by the Dialysis Outcomes Quality Initiative. While the Optiflow delivered higher flow rates at some measurement points, this was offset by higher recirculation. The Ash catheter showed a long-term survival advantage and fewer late complications.
authors.affiliation: Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA. streroto@uphs.upenn.edu
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.forename: Michael
authors.initials: M
authors.lastname: Kraus
authors.forename: Himanshu
authors.initials: H
authors.lastname: Shah
authors.forename: Jan
authors.initials: J
authors.lastname: Namyslowski
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Johnson
authors.forename: Michael S
authors.initials: MS
authors.lastname: Stecker
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmad
authors.forename: Gordon
authors.initials: G
authors.lastname: McLennan
authors.forename: Nilesh H
authors.initials: NH
authors.lastname: Patel
authors.forename: Elaine
authors.initials: E
authors.lastname: O'Brien
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: Walter T
authors.initials: WT
authors.lastname: Ambrosius
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*