Acute vascular access catheters for haemodialysis: complications limiting technique survival

The use of acute vascular access catheters (AVACs) has facilitated the delivery of haemodialysis to patients lacking functioning access. A review of the experience of a tertiary Australian renal treatment centre, consisting of 205 sequential AVACs in 93 patients, was undertaken over 1 year, to identify issues limiting technique survival. Acute vascular access catheters were inserted as acute dialysis access for patients with chronic renal failure (CRF; 21%), failed grafts or fistulae (18%), acute renal failure (12%), failed chronic ambulatory peritoneal dialysis (CAPD; 8%) or failed prior AVACs (37%). The majority of AVACs were on the right (74%), and the placement site was simple jugular (69%), tunnelled jugular (15%), femoral (12%), or subclavian (4%). During follow up, 198 of 205 AVACs were removed. The mean AVAC survival was superior (P < 0.0001, Fisher's protected least significant difference (PLSD) for tunnelled jugular AVACS (62 +/- 46 (SD) days) compared with simple jugular (20 +/- 19), subclavian (18 +/- 13) and femoral (7 +/- 6). Causes for AVAC removal were: elective (47%), blockage (31%), infection (20%) or cracked catheter (1%). Routine postremoval tip cultures grew coagulase negative Staphylococcus (CNS, 46%), negative culture (33%), methicillin-resistant Staphylococcus aureus (MRSA; 9%), Staphylococcus aureus (9%), Gram-negative rods (1%), Pseudomonas (0.5%) or other uncommon organisms (2%). Blood cultures were drawn through the AVAC in the setting of suspected bacteraemia in 42 of 198 AVACs. Blood cultures were negative in 40%. Positive cultures included Staphylococcus species in 55%: including MRSA (19%), Staphylococcus aureus (29%) and CNS (34%). Rare cultures identified Escherichia coli (2%) or Serratia (2%). Infection and blockage significantly reduced AVAC survival, affecting more than 50% of cases. Approaches to minimize these complications are likely to lead to improved clinical outcomes with AVAC use.