Frequency, therapy, and prevention of infections associated with large bore catheters

Since the introduction of large bore catheters for acute hemodialysis 30 years ago, many problems with handling, material, and contamination of these catheters existed. Nevertheless, the catheterization of the inferior and superior vena cavae with a large bore catheter has proved to be suitable as a rapid connection process for hemodialysis, hemofiltration, hemoperfusion, plasmapheresis, plasmaperfusion, etc. In a retrospective study with 2,626 large bore catheters in 1,627 patients, the frequency of infections, thrombosis, bleeding, and other side effects was investigated. All complications and side effects are presented dependent upon vascular access route. In total, the complication rate was 44.2% higher in subclavian puncture than in internal jugular puncture at 23.9%. The highest complication rates in both vascular access routes were infections or septicemia; infections were observed in 22.8% of subclavian catheters versus 9.5% of internal jugular catheters. Three different catheter materials (Teflon, polyurethane, and polypropylene) were investigated with scanning electron microscopy after removal. The advantages and disadvantages of the different materials are presented.