title: Translumbar central venous catheters for long-term haemodialysis.
abstract: BACKGROUND
  Vascular access for haemodialysis is achieved by tunnelled central venous catheter (CVC) in at least 23% of prevalent patients in the UK, Canada and the USA. Use of CVCs is associated with an increased incidence of venous stenosis that can progressively limit future vascular access routes. Lack of conventional venous access routes mandates the use of alternative strategies such as the translumbar approach.
  
  
  METHODS
  We retrospectively analysed patients at our centre requiring translumbar inferior vena caval CVCs (TesioCath) for haemodialysis in the period 1999-2008. Written and electronic records capturing dialysis adequacy and complications, hospital admissions and laboratory data were examined.
  
  
  RESULTS
  Thirty-nine pairs of translumbar CVCs were inserted in 26 patients with 15 864 catheter days follow-up, mean patient age 61.9 +/- 12.1 years, 31% diabetic, 15% with ischaemic heart disease. All insertions were successful. Insertion of one CVC was associated with a self-limiting retroperitoneal haematoma. No patients died of a catheter-related cause or through lack of vascular access. Cumulative assisted primary catheter site patency was 81% at 6 months and 73% at 1 year (median 18.5 months). Good dialysis adequacy was achieved throughout (mean single-pool Kt/V 1.5 +/- 0.4). The incidence of access-related infection was 2.84/1000 catheter days (exit site infection rate 2.02/1000 catheter days; catheter-related bacteraemia rate 0.82/1000 catheter days). Catheter dysfunction (need for thrombolytic infusion or catheter change) led to 0.88 admissions per 1000 catheter days.
  
  
  CONCLUSIONS
  Translumbar inferior vena caval CVCs can offer relatively safe and effective long-term haemodialysis access in patients with no other options.
authors.affiliation: Imperial College Kidney and Transplant Institute, West London Renal and Transplant Centre, Imperial College Healthcare Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK. albert.power@imperial.nhs.uk
authors.forename: Albert
authors.initials: A
authors.lastname: Power
authors.forename: Seema
authors.initials: S
authors.lastname: Singh
authors.forename: Damien
authors.initials: D
authors.lastname: Ashby
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hamady
authors.forename: Steve
authors.initials: S
authors.lastname: Moser
authors.forename: Wady
authors.initials: W
authors.lastname: Gedroyc
authors.forename: David
authors.initials: D
authors.lastname: Taube
authors.forename: Neill
authors.initials: N
authors.lastname: Duncan
authors.forename: Thomas
authors.initials: T
authors.lastname: Cairns
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation* / Q000401:mortality