Prospective evaluation of a Dacron cuffed hemodialysis catheter for prolonged use

Double lumen subclavian venous hemodialysis catheters are in wide use in the United States to provide temporary vascular access. The disadvantages of these catheters include a high infection rate and short use-life (2 to 3 weeks). We evaluated a felt cuffed tunnelled jugular venous hemodialysis catheter (PermCath) to determine its ability to overcome these shortcomings and compared it with standard noncuffed double lumen dialysis catheters. Eighty PermCaths were inserted during this prospective study in patients needing temporary vascular access in excess of 1 month. Median use-life of these catheters was 8 weeks with a use range of 3 weeks to 5.4 months. Only four functioning catheters failed before elective removal. Despite the prolonged use-life there was only one episode of catheter mediated bacteremia. Seven catheters (9%) failed to function immediately after insertion. These failures were caused by catheter kinking in the region of the felt cuff. Thrombosis of the catheter lumen was the most frequent complication (137 episodes) but resolved in over 95% of the instances with urokinase instillation. Exit site infections (23 instances) were successfully treated conservatively. We conclude that the PermCath (Quinton Instrument Co, Seattle) is a safe and reliable new device with a low complication rate and a longer use-life than standard subclavian dialysis catheters. This longer use-life allows more time for maturation of primary arteriovenous (AV) fistulas and Tenckhoff peritoneal dialysis catheters, and provides time for the healing of infected vascular access grafts. Its primary disadvantage is the need for surgical insertion.