title: Tesio-Caths provide effective and safe long-term vascular access.
abstract: BACKGROUND
  Vascular access is judged on its ability to provide good dialysis adequacy, its durability and complication rates. Formation of a functional arteriovenous fistula is desirable but difficult to achieve in a significant proportion of patients. We report the large-scale use of Tesio-Caths, a twin-line single-lumen central venous catheter, to maximize dialysis adequacy where formation of an arteriovenous fistula was not possible.
  
  
  METHODS
  All patients who had Tesio-Caths inserted between 1 January 1999 and 1 October 2002 were studied.
  
  
  RESULTS
  Six hundred and twenty-three Tesio-Caths were inserted from 1 January 1999 to 1 October 2002 in 435 patients, generating 7464 patient months of follow-up. Five hundred and ninety-four out of 623 (95.3%) Tesio-Caths were immediately functional. Mean dialysis adequacy measured by single-pool Kt/V was 1.5+/-0.3 for all Tesio-Caths for the entire period of study, with 68% of Tesio-Caths delivering a Kt/V >1.4. Cumulative functional Tesio-Cath survival to final failure was 77.8 and 44% at 1 and 3 years, respectively. Cumulative patient survival was 84.7, 71.4 and 63% at 1, 2 and 3 years, respectively. Access-related infection accounted for 0.28 admissions/1000 catheter days, and the death rate from access-related sepsis was 9.6 deaths/1000 patient years at risk. The admission rate for access dysfunction was 0.33/1000 patient years at risk.
  
  
  CONCLUSIONS
  Tesio-Caths provide good dialysis adequacy for patients in whom an arteriovenous fistula cannot be formed. Patient and functional access survival for this group was comparable with current European data irrespective of vascular access type. Complication rates were acceptably low.
authors.affiliation: Renal and Transplant Unit, St Mary's Hospital, London, UK. neillduncan@hotmail.com
authors.forename: Neill D C
authors.initials: ND
authors.lastname: Duncan
authors.forename: Seema
authors.initials: S
authors.lastname: Singh
authors.forename: Thomas D H
authors.initials: TD
authors.lastname: Cairns
authors.forename: Martin
authors.initials: M
authors.lastname: Clark
authors.forename: Adil
authors.initials: A
authors.lastname: El-Tayar
authors.forename: Megan
authors.initials: M
authors.lastname: Griffith
authors.forename: Nadey
authors.initials: N
authors.lastname: Hakim
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hamady
authors.forename: Adam G
authors.initials: AG
authors.lastname: McLean
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papalois
authors.forename: Andrew
authors.initials: A
authors.lastname: Palmer
authors.forename: David
authors.initials: D
authors.lastname: Taube
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D018805:Sepsis / Q000209:etiology / Q000382:microbiology