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Factors and complications affecting catheter and technique survival with permanent single-lumen dialysis catheters
J De Meester1, R Vanholder, J De Roose
1Department of Nephrology, University Hospital, Ghent, Belgium.
Insights
Permanent silicone dialysis catheters show good long-term performance in haemodialysis, especially for the elderly. Avoiding left jugular vein insertion and catheters without side holes improves outcomes.
Area of Science:
- Nephrology
- Vascular Access
- Medical Devices
Background:
- Permanent silicone single-lumen dialysis catheters are used for long-term haemodialysis.
- Assessing the long-term outcomes and complications of these devices is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the long-term outcomes, survival rates, and complication incidence of permanent silicone single-lumen dialysis catheters.
- To identify factors influencing catheter and technique survival.
Main Methods:
- A long-term study involving 43 surgically inserted catheters in 33 patients using a pressure-pressure single-cannula dialysis system.
- Analysis of technique and catheter survival rates at 1 and 3 years, and assessment of complication incidences.
Main Results:
- Catheter and technique survival rates were 80% and 59% at 1 year, and 63% and 50% at 3 years, respectively.
- Left jugular vein placement and absence of distal side holes were associated with poorer outcomes.
- Infectious complications and inadequate flow rates decreased over time, with inadequate flow more common early post-insertion.
Conclusions:
- Permanent single-lumen silicone catheters demonstrate acceptable long-term performance for haemodialysis, suitable as a primary vascular access, particularly in elderly patients.
- Avoiding specific insertion sites (left jugular vein) and catheter designs (without side holes) can enhance catheter survival.
Abstract:
This long-term study on the outcome of permanent silicone single-lumen dialysis catheters consisted of 43 surgically inserted catheters in 33 patients. All catheters were attached to a pressure-pressure single-cannula dialysis system. Technique and catheter survival were 80 and 59% at 1 year, and 63 and 50% at the 3rd year respectively. These parameters were not different in older patients (> or = 70 years, n = 12). Factors corresponding to a less successful outcome were placement in the left jugular vein (3-month actuarial survival of 44%) and absence of distal side holes (1-year actuarial survival of 44%). Insertion in both subclavian veins was not different to the classical right jugular vein. Infectious complications (incidence of 0.72 per 1000 catheter days) often caused simultaneous catheter and technique failure (14 versus 15%), whereas inadequate flow (incidence of 2 per 1000 catheter days) caused catheter rather than technique failure (30 versus 12%). The incidence of both complications declined significantly with time after insertion during the follow-up period. The first 3 months after insertion were more predisposed to the occurrence of inadequate flow than catheter-related infections. The general performance of these permanent single-lumen catheter devices justifies their long-term application in haemodialysis, even as a first choice of vascular access, especially in the elderly. Insertion in the left jugular vein and use of catheters without side holes should be avoided, providing a better catheter survival.