title: Factors affecting long-term survival of tunnelled haemodialysis catheters--a prospective audit of 812 tunnelled catheters.
abstract: BACKGROUND
  In 2001, in the US, 23% of haemodialysis patients were dialysing through tunnelled venous catheters (TVCs), and in the UK (2006) there were 28% of prevalent patients using catheters. It is unlikely that numbers will significantly decrease. We present the results of a prospective audit of the survival of 812 TVCs placed in 492 patients at our institution over a 6-year period (comprising 212 048 patient catheter days or 7068 patient catheter months of follow-up). Four different designs of catheter were studied: Split-Cath III (Medcomp), HemoSplit (Bard), Tesio twin catheter (Medcomp) and Permcath (Quinton).
  
  
  METHODS
  We used Kaplan-Meier survival analysis with log-rank test, to compare the effect of different parameters on catheter survival. The relative importance of significant parameters was determined by Cox regression analysis.
  
  
  RESULTS
  We have shown a significant catheter survival advantage of first catheters over second and subsequent insertions, of right internal jugular site over left internal jugular and thereafter over femoral site, and of non-diabetic over diabetic patients. Patient age, sex and operator (physician in ward-based procedure room under ultrasound control or surgeon in operating theatre under fluoroscopic assistance) did not significantly affect survival. The Permcath design demonstrated inferior survival in all but first catheter insertions in catheter-naïve patients. The HemoSplit and Tesio twin catheter designs demonstrated best survival overall. By Cox proportional hazard modelling the design and the position of the TVC seemed to be the most significant independent survival factors.
  
  
  CONCLUSIONS
  Clinicians need accurate data regarding catheter survival, mode of insertion and design, to inform practice.
authors: Lister Renal Unit, Lister Hospital, Stevenage, Hertfordshire, England.
authors: Andrew C
authors: AC
authors: Fry
authors: Jon
authors: J
authors: Stratton
authors: Ken
authors: K
authors: Farrington
authors: Kapil
authors: K
authors: Mahna
authors: Sadasivam
authors: S
authors: Selvakumar
authors: Hilary
authors: H
authors: Thompson
authors: Paul
authors: P
authors: Warwicker
mesh_terms: D002404:Catheterization / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D013997:Time Factors