Temporary vascular catheters for hemodialysis: a 3-year prospective study.
BACKGROUND
Temporary hemodialysis catheters are necessary in patients with uremia, but complications associated with these catheters represent one of the most important sources of morbidity among ESRD patients. There is no general agreement about the optimal venous access for insertion of a central venous catheter, while risk factors of catheter related complications have not been entirely elucidated.


METHODS
One hundred and seven consecutive patients who required a temporary hemodialysis catheter were prospectively examined.


RESULTS
Catheters were placed in 107 consecutive patients (66 right jugular (JC), 41 right femoral (FC)) and maintained in situ for a cumulative total of 2101 days. Early complications (puncture site hemorrhage, hematoma formation, artery puncture) were infrequent, without clinical sequelae. The main late complication was catheter related bacteremia (CRB). There were 16 episodes of CRB (JC-10; FC-6) and Staphylococcus aureus was the most frequently isolated cause of CRB. The mean catheter duration before the onset of CRB was 19.9 and 18.2 days for JC and FC, respectively. Duration of catheter use, and the number of hemodialyses significantly increased the risk for CRB. Actuarial survival for FC was significantly worse than for JC, while Cox proportional hazard models revealed that the femoral site, chronic renal failure and kidney transplantation increased the risk of catheter failure significantly.


CONCLUSIONS
CRB was the most common late complication. Its frequency was similar in JC and FC. The main risk factors for development of CRB were duration of catheter use and the number of performed dialyses. Cumulative hazard of CRB was significantly magnified 3 weeks after insertion for both JC and FC, but actuarial survival with JC was significantly longer.
Naumovic
R T
RT
Clinic of Nephrology, Institute of Urology and Nephrology, Clinical Center of Serbia, Belgrade - Serbia and Montenegro. rnaumovic@drenik.net
Jovanovic
D B
DB
Djukanovic
L J D
LJ
D016470:Bacteremia / Q000209:etiology; D001424:Bacterial Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein; D006406:Hematoma / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007084:Iliac Vein; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects; D006435:Renal Dialysis / Q000295:instrumentation*; D051437:Renal Insufficiency / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology