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[Permanent vascular catheters: Effectiveness and duration of the Ash-Split Cath]
1Unita' Operativa di Nefrologia e Dialisi, Presidio Ospedaliero di Monselice (PD), Italy.
Insights
The Ash Split Cath provides an effective alternative for chronic hemodialysis when traditional fistulas are not feasible. This study found no infections or significant recirculation issues in patients using this tunnelled catheter.
Area of Science:
- Nephrology
- Vascular Access
- Medical Devices
Background:
- Chronic hemodialysis often requires reliable vascular access, with native arteriovenous fistulas being the preferred method.
- Tunnelled catheters serve as a crucial alternative when fistulas are not viable due to factors like venous thrombosis or poor venous anatomy.
- The Ash Split Cath (ASC) is a novel tunnelled catheter designed for chronic hemodialysis.
Purpose of the Study:
- To evaluate the efficacy and safety of the Ash Split Cath (ASC) in patients requiring chronic hemodialysis.
- To assess key performance indicators such as blood flow rates, venous pressures, and dialysis adequacy (Kt/V).
- To monitor for complications, including infection and recirculation, associated with ASC use.
Main Methods:
- The Ash Split Cath was inserted in nine prevalent hemodialysis patients who were unsuitable for native arteriovenous fistulas.
- Patient selection criteria included a history of recurrent venous thrombosis or poor venous tree.
- Hemodynamic parameters (blood flow, venous pressure), recirculation, dialysis dose (Kt/V), and clinical outcomes (infection) were monitored post-insertion.
Main Results:
- The average blood flow rate achieved was 250 +/- 50 mL/minute, with a mean venous pressure of 140 +/- 35 mm Hg.
- Recirculation, assessed by the low flow technique, was consistently below 5%.
- Four months post-insertion, the calculated Kt/V averaged 1.2 +/- 0.02, indicating adequate dialysis dose, and no exit site or catheter-related infections were observed.
Conclusions:
- The Ash Split Cath demonstrates promising results as a safe and effective tunnelled catheter for chronic hemodialysis.
- It provides adequate blood flow and dialysis dose while showing a low incidence of complications like recirculation and infection.
- ASC represents a viable option for patients with challenging venous access, particularly those experiencing repeated venous thrombosis.
Abstract:
In absence of a permanent and useful native arterio-venous fistula, the use of a tunnelled catheter allows dialysis therapy to be carried out. The Ash Split Cath is a recently introduced chronic hemodialysis catheter. An ASC was inserted in nine patients (7.1% of our prevalent dialysis population), for repeated venous thrombosis in seven patients and a poor venous tree in two. The average blood flow rate was 250 +/- 50 mL/minute and the mean venous pressure measured was 140mm Hg +/- 35. Recirculation determined by low flow technique was less than 5% and 4 months after the catheter placement, calculated Kt/V, was 1.2 +/- 0.02. During the follow up we did not document any infection of the exit site or related to the catheter.