Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients.
The objective was to review our experience with temporary, precurved, jugular catheters used for long-term vascular access in chronic hemodialysis patients. Thirty chronic hemodialysis patients, 14 men and 16 women, with an average age of 65.3 +/- 13.5 years (30-90 years), treated by dialysis for 1 month to 30 years (average +/- SD, 6.3 +/- 8.1 years), had single lumen, 'temporary' precurved non-tunneled jugular catheters placed into the right jugular vein as permanent vascular access, with 4% trisodium citrate as a locking solution and mupirocin at the exit site. Hemodialysis catheters were used for vascular access on average for 9.1 +/- 6.5 months, (1-22.7 months), and for a total of 271.7 months (8151 days). Average catheter functioning time was 3.1 +/- 1.9 months (0.5-10 months). The total number of side-effects was 55 (6.7/1000 catheter days), including 26 cases of thrombosis (3.2/1000 catheter days), 9 ruptures of the catheter (1.1/1000 catheter days), 15 catheter malfunctions (1.8/1000 catheter days), 2 exit site infections (0.2/1000 catheter days), 2 bacteremias (0.2/1000 catheter days), 1 avulsion of the catheter (0.1/1000 catheter days), and 2 catheters were removed because an AV fistula was successfully used. In 21 patients single-needle hemodialysis was performed, mean blood flow 251 +/- 16 mL/min (250-300), mean Kt/V 0.96 +/- 0.16 (0.72-1.27) and in 9 patients double-needle hemodialysis was performed (catheter and peripheral vein) with mean blood flow 252 +/- 14 mL/min (200-300), mean Kt/V 1.63 +/- 0.25 (1.21-1.96). 'Temporary' jugular single lumen non-tunneled hemodialysis catheters, with 4% citrate as locking solution and mupirocin ointment at the exit site provided good long-term vascular access with acceptable functioning time and low infection rate. The main reasons for catheter exchange or removal were malfunction and mechanical damage of the catheter.
Ponikvar
Rafael
R
Department of Nephrology, University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia. rafael.ponikvar@kclj.si
Buturović-Ponikvar
Jadranka
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D016470:Bacteremia / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002951:Citrates / Q000627:therapeutic use; D005260:Female; D018056:Hemorheology; D006801:Humans; D007601:Jugular Veins; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D006435:Renal Dialysis / Q000295:instrumentation*; D000077559:Sodium Citrate; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D002951:Citrates; D000077559:Sodium Citrate; D016712:Mupirocin