title: Survival and complications of indwelling venous catheters for permanent use in hemodialysis patients.
abstract: BACKGROUND
  The risk factors influencing the survival of indwelling central vein catheters and their potential complications have not been assessed in depth and on a large scale.
  
  
  METHODS
  We investigated the general characteristics of 245 single lumen cuffed tunneled catheters and analyzed their survival by Kaplan-Meier and Cox regression analysis. Risk factors for bacteremia and thrombosis were assessed by logistic regression analysis.
  
  
  RESULTS
  The incidence of exit-site infection, tunnel infection, bacteremia and thrombotic events was 0.35, 0.25, 1.71, and 1.94/1000 catheter days, respectively. The mean survival time per catheter was 276 days. After censoring for non catheter-related events leading to the removal of the catheter (n = 245 with 120 catheters censored and 125 events), the mean survival time of the catheter appeared to be 615 +/- 67 days (95% CI of 483-747) and the median survival time 310 +/- 50 days (95% CI of 212-408). The localization of the catheter into the right internal jugular vein results in significantly better survival as compared with other insertion sites both in Kaplan-Meier (mean survival of 650 days compared to a mean survival of 519 days, P value < 0.009) and in Cox regression analysis (relative risk of 0.537, P value < 0.001). Localization of the catheter into the right internal jugular vein seemed to increase the risk for bacteremia (relative risk of 1.798, P value of 0.063). The use of anticoagulant agents was not protective for thrombosis, although this might be due to lack of power (relative risk of 0.626, P value of 0.141).
  
  
  CONCLUSIONS
  We provide evidence of a mean survival in long-term hemodialysis catheter close to 2 years with an acceptable complication rate. If a long-term hemodialysis catheter is required, it is best placed in the right internal jugular vein.
authors.affiliation: Renal Division, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium. wdevelter@skynet.be
authors.forename: Willem
authors.initials: W
authors.lastname: Develter
authors.forename: Antoine
authors.initials: A
authors.lastname: De Cubber
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
mesh_terms: D002408:Catheters, Indwelling / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007239:Infections / Q000209:etiology; D007674:Kidney Diseases / Q000628:therapy*; D016015:Logistic Models; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology