A multicenter, prospective, randomized, comparative evaluation of dual- versus triple-lumen catheters for hemodialysis and apheresis in 485 patients.
BACKGROUND
The purpose of this study is to compare a new temporary triple-lumen catheter (TLC) for dialysis that has a third lumen devoted to fluid and medication administration or blood sampling with a marketed dual-lumen catheter (DLC).


METHODS
Four hundred eighty-five patients referred for acute hemodialysis or apheresis were randomly assigned to either a TLC or DLC in a multicenter, prospective, randomized trial.


RESULTS
Analysis of blood flow rates was completed on 464 patients (228 patients, DLC; 236 patients, TLC) with a total of 1,681 hemodialysis (808 treatments, DLC; 873 treatments, TLC) and 82 apheresis treatments (37 treatments, DLC; 45 treatments, TLC). During hemodialysis, a median achieved flow rate (AFR) of 267 mL/min was realized for both groups (P = 0.58). During apheresis, a median AFR of 72.5 mL/min (range, 50 to 150 mL/min) was achieved in the DLC group, and 87 mL/min (range, 60 to 150 mL/min), in the TLC group (P = 0.14). Three hundred ninety-three patients (193 patients, DLC; 200 patients, TLC) had blood and catheter tip cultures performed on removal, and catheter-related bloodstream infection (CRBSI) status was determined. Thirty-one patients (7.9%) had a CRBSI: 16 patients (8.3%), DLC; and 15 patients (7.5%), TLC (P= 0.77). Incidence densities of CRBSI were 12.4/1,000 DLC-days and 10.2/1,000 TLC-days (P = 0.59). The CRBSI incidence of 18.2/1,000 catheter-days for femoral sites was significantly greater than the 7/1,000 catheter-days for jugular sites (P = 0.02) and 6.6/1,000 catheter-days for combined jugular and subclavian sites (P = 0.01). In multivariate analysis, antibiotic use was the only factor related to CRBSI (odds ratio, 0.30; 95% confidence interval, 0.12 to 0.76). There were no statistically significant differences in rates of other complications between the 2 catheters.


CONCLUSIONS
Results show that the new TLC is similar to the marketed DLC.
Contreras
Gabriel
G
Division of Nephrology, University of Miami School Medicine, Veterans Administration Medical Center, Miami, FL 33136, USA. gabriel.contreras@med.va.gov
Liu
Ping-Yu
PY
Elzinga
Lawrence
L
Anger
Michael S
MS
Lee
Jean
J
Robert
Nurian
N
Chvala
Robert
R
Mars
Ronald L
RL
Vesely
Thomas
T
Taber
Tim E
TE
Shemin
Douglas
D
Shafritz
Randy
R
Pulliam
Joseph
J
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D001781:Blood Component Removal / Q000295:instrumentation*; D002404:Catheterization / Q000009:adverse effects; D003920:Diabetes Mellitus / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D005268:Femoral Vein; D018056:Hemorheology; D006801:Humans; D015994:Incidence; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012307:Risk Factors
D000900:Anti-Bacterial Agents