Percutaneously placed dual-lumen silicone catheters for long-term hemodialysis

Dual-lumen Dacron-cuffed silicone hemodialysis catheters placed percutaneously under fluoroscopic control have been used by us in 200 patients since July 1986. A total of 246 catheters were placed in 4 years, of which 172 were for long-term hemodialysis in place of prosthetic tube bridge arteriovenous shunts. One-year catheter survival estimate by Kaplan-Meier life table was 57 per cent, and mean survival estimate was 16.3 months. There were a combined 76 patient years of catheter experience, with some catheters lasting as long as 2 1/2 years. Catheter thrombosis occurred in 92 catheters, but 83 per cent of cases responded to thrombolytic therapy. There were exit site infections with thirty-nine catheters, but 90 per cent resolved with antibiotic therapy. Twenty-two bacteremias occurred with 19 catheters, which resulted in 15 catheter removals. The remaining seven cases of bacteremia responded to antibiotic therapy without catheter removal. Subclavian vein or superior vena cava thrombosis has not been a problem. Silicone catheters are a practical alternative to prosthetic tube bridge arteriovenous shunts for long-term hemodialysis.