title: Two single-lumen noncuffed catheters in the jugular vein as long-term vascular access: a preliminary report.
abstract: Two single-lumen, noncuffed catheters in the same jugular vein have been used as preferred vascular access in our hemodialysis (HD) and apheresis patients in past years. The aim of this retrospective study was to analyze the clinical outcome of such a vascular access and the reasons for catheter removal. In 129 adult patients, aged 69 ± 13 years, 56% males, treated by HD (121 patients) or apheresis (8 patients), two single lumen, pre-curved 8 Fr catheters (Medcomp, Harleysville, PA, USA) inserted into the same jugular vein were used as vascular access between January 2009 and April 2010. The catheters were inserted into the left jugular vein in 21 patients, and into the right jugular vein in 108 patients. A 30% solution of trisodium-citrate was used as a locking solution, and 2% mupirocin ointment was routinely applied to the exit site. The catheters were removed in 86 patients after 1-288 days, median 17.5 days. In 74 patients, there was either no need for further dialysis or an arteriovenous fistula was constructed (17 patients). In 10 patients, wire exchange was performed for correction of a displaced functional catheter (after 6-201 days), and in only two patients the catheters were removed due to infection on days 10 and 184. The longest period of a catheter functioning without intervention was 387 days. Fifteen patients died with functional catheters left in place (duration 1-387 days). In four patients, the catheters were still functional at the time of analysis (duration 198-268 days). Another nine patients were transferred to other dialysis centers (after they had been followed up at our center lasting for 1-63 days), with no data on their outcome after transfer. Fifteen patients were lost to follow up after insertion. Two single-lumen, noncuffed catheters in the same jugular vein, locked with 30% citrate, seem to be a safe and long lasting method of vascular access for hemodialysis and apheresis in some patients, but further prospective studies are needed to evaluate the clinical outcome of this type of vascular access.
authors.affiliation: Department of Nephrology, University Medical Center, Ljubljana, Slovenia. janko.kovac@kclj.si
authors.forename: Janko
authors.initials: J
authors.lastname: Kovač
authors.forename: Vladimir
authors.initials: V
authors.lastname: Premru
authors.forename: Jadranka
authors.initials: J
authors.lastname: Buturović-Ponikvar
authors.forename: Rafael
authors.initials: R
authors.lastname: Ponikvar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage; D001781:Blood Component Removal / Q000379:methods*; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002951:Citrates / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D002951:Citrates; C514290:trisodium citrate; D016712:Mupirocin