[Subcutaneously tunnelled cuffed venous hemodialysis catheters in chronic renal failure]

Silastic cuffed catheters play an increasing role in providing long-term vascular access for hemodialysis. The reasons for this were related to increased patient age and an increased number of patients who had exhausted sites for vascular access. We report our experience with subcutaneously tunnelled cuffed hemodialysis catheters.

From May 1, 2001 to February 28, 2003, 258 consecutive hemodialysis catheters were placed in 203 patients (122 men, mean age 70 +/- 12 years) as access for hemodialysis (1.3 catheters/patient). Catheter implantation was explained to all patients and a protocol consent form was signed. The catheter was implanted via the internal jugular, subclavian or femoral vein and the correct final catheter position was determined fluoroscopically. Short and long-term catheter-associated complications were collected from the time of catheter insertion until a follow up of at least 6 months after implantation.

The mean duration of implantation procedure was 38 +/- 12 minutes with an initial clinical success rate of 100 % and a periprocedural complication rate of 6 %. The median catheter indwell time was 9 months with a primary patency rate of 72 % at the end of the follow-up. Inadequate flow rate < 200 ml/min was noted at one per 41 patient-months but sufficient blood flow was restored in 50 % of these patients with non- or semi-invasive interventions. Bacteremic episodes occurred at a rate of one episode per 16 patient-months. Catheter removal due to severe exit site infections or bacteremic episodes were necessary at one per 73 patient-months. There were no cases of bacterial endocarditis.

Subcutaneously tunnelled cuffed venous hemodialysis catheters are a safe und highly feasible vascular access with a low complication rate and a long use-life especially for elder patients with limited life expectancy, exhausted sites for vascular access or in case of failing hemodialysis arteriovenous fistulas.