Surgical management of long-term central venous access in uraemic patients

Over a 5-year period, 1980-1985, 39 patients from a dialysis population of over 400 treated at this centre experienced major difficulties in achieving adequate access for dialysis by conventional techniques (i.e. arteriovenous fistula or CAPD). This study has evaluated the long-term results of a new approach to circulatory access, central venous catheterisation (CVC) for so called "high risk" patients. CVC consists of inserting a single-lumen CAPD-type silastic catheter into the right atrium via an external or internal jugular vein. Forty-seven catheters have been inserted into 39 uraemic patients. All patients had failed on, or were unsuitable for, conventional access to haemodialysis or CAPD. Ten patients (26%) had previous failed renal transplants. The median duration of catheter use was 7 months (range 1-60 months) and a total of 6500 high-performance dialyses have been performed using this technique. No patient has died of catheter-related problems. The catheters were easily managed by nurses and well tolerated by the patients. The incidence of complications among patients was low: displacement (1), catheter thrombosis (2), skin exit-site infections (5), septicaemia (2). Central venous catheterisation is a method of providing safe and reliable long-term vascular access which is immediately usable by high-risk patients who have either failed on or are unsuitable for conventional circulatory access.