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[Long-term development of Permacath Quinton catheters used as a vascular access route for extra-renal detoxification]
D Dupont1, P Morinière, T Pourchez
1CHR d'Amiens, Service d'Hémodialyse, Amiens.
Insights
The Permcath Quinton catheter provides adequate long-term hemodialysis vascular access. Despite a 29% obstruction rate, it is well-tolerated and preferred by many patients over arteriovenous fistulas.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Devices
Background:
- Hemodialysis requires reliable vascular access.
- Traditional vascular access methods like arteriovenous fistulas can face challenges.
- Alternative access methods are crucial for specific patient populations.
Purpose of the Study:
- To evaluate the efficacy and safety of the Permcath Quinton catheter for hemodialysis.
- To assess the Permcath Quinton catheter's suitability as a long-term vascular access solution.
- To analyze complication rates and patient tolerance of the catheter.
Main Methods:
- Surgical insertion of 147 Permcath Quinton catheters in 126 uremic patients over 7 years.
- Categorization of patients into groups based on the reason for catheter insertion (acute/chronic renal failure, access issues, short life expectancy).
- Monitoring of catheter usage duration and complication incidence.
Main Results:
- Catheters were used for varying durations across different patient groups, with some patients preferring them over arteriovenous fistulas.
- Observed complications included septicemia (2 deaths), local infections, catheter obstructions (29% total or partial), and catheter destruction.
- Infection incidence was noted as low, but obstruction was a frequent issue requiring treatment.
Conclusions:
- The Permcath Quinton catheter is an adequate and well-tolerated long-term vascular access for hemodialysis.
- Patient preference for the catheter over arteriovenous fistulas highlights its usability.
- While infection rates are low, the high incidence of obstruction necessitates management strategies like fibrinolytic treatment.
Abstract:
Between July 1984 and July 1991, we have inserted surgically 147 Permcath Quinton catheters in 126 uremic patients for the following reasons: group I: necessity of hemodialysis without vascular access for acute (group Ia: 44 patients) or chronic renal failure (group Ib: 11 patients); group II: difficulty of creation or loss of vascular access (group II: 45 patients); group III: hemodialysis for patients with short life expectation or contraindications for vascular access on their limbs (group III: 26 patients). The duration of use (+/- SD and range) were respectively for each group: 1.6 +/- 2 (0-10); 3.4 +/- 2.8 (1-11); 7.4 +/- 11 (0-50); 6.7 +/- 8.7 (0.1-34.5) months. Seventeen patients (group IV) coming from groups Ib and II preferred to go on with the use of their catheter for 10.5 +/- 13.5 (0.1-50) months rather than to use their arteriovenous fistula. The complications observed on whole population were: 11 septicemia responsible of 2 deaths, 9 cutaneous local infections, 28 total obstructions of the catheter, 17 partial obstructions with insufficient flow; 10 destructions of the catheter. In conclusion the Permcath Quinton catheter is an adequate long term vascular access for hemodialysis. It is well tolerated since it is preferred to the usual arteriovenous fistula by many patients who have both. The incidence of infection is low. However, obstruction (partial ou total) is frequent (29%), necessitating local fibrinolytic treatment.