title: Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate.
abstract: OBJECTIVE
  Central venous tunnelled hemodialysis catheters (CVTC) are used for initial vascular access in patients with renal failure. Tip design of the CVTC may play an important role in catheter function and complication rates, influencing adequate hemodialysis treatment of these patients.
  
  
  METHODS
  This prospective, observational cohort study compared the function and complication rates of two CVTCs in patients with end stage renal disease (ESRD) within a follow-up period of 24 months. The study included patients with ESRD who received either a CVTC with a split tip (ST) or a shotgun tip (SG). All patients underwent dialysis within 24 h of intervention. Blood flow was documented initially (Qb0) and was followed up after 6 (Qb6), 12 (Qb12), and 24 (Qb24) months. Analysis of blood flow and complication rates within the follow-up period was performed by questionnaires.
  
  
  RESULTS
  In total, 185 patients were included, of whom 93 received a ST CVTC and 92 a SG CVTC. Baseline parameters did not differ significantly between groups. CVTC blood flow was not significantly different between the two devices. Thrombolytic therapy with Alteplase was used significantly more often in the ST group (29%) than in the SG group (16%) (p < 0.05). The CVTC replacement rate was significantly higher in the ST group (19.3%) compared with the SG group (8.7%) (p < 0.05).
  
  
  CONCLUSIONS
  The tip design of CVTC (split or shotgun) appears to be irrelevant for long-term blood flow during dialysis treatment. However, patients may benefit from SG catheters over ST catheters where replacement rates and thrombolytic treatment are concerned.
authors.affiliation: Department of Vascular Surgery, St. Adolf-Stift Hospital Reinbek, Reinbek, Germany; Elmshorn Vascular Center, Division of Vascular Surgery, Sana Clinic Elmshorn, Elmshorn, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Petridis
authors.affiliation: Medical Clinic I, Division of Nephrology, University of Lübeck, Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Nitschke
authors.affiliation: Medical Clinic I, Division of Nephrology, University of Lübeck, Lübeck, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Lehne
authors.affiliation: Medical Clinic I, Division of Nephrology, University of Lübeck, Lübeck, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Smith
authors.affiliation: Clinic of Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Goltz
authors.affiliation: Medical Clinic I, Division of Nephrology, University of Lübeck, Lübeck, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lehnert
authors.affiliation: Medical Clinic I, Division of Nephrology, University of Lübeck, Lübeck, Germany; Nephrology Center Reinbek and Geesthacht, Reinbek, Germany. Electronic address: markus.meier@dialyse-reinbek.de.
authors.forename: M
authors.initials: M
authors.lastname: Meier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D061807:Catheter Obstruction / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Hemodialysis; Hemodialysis catheter; Thrombolysis; Tip design; Tunneled dialysis catheter