Vascular screening prior to placement of tunnelled and cuffed hemodialysis catheters

Purpose: To demonstrate the importance of venous vascular screening before the placement of tunneled and cuffed hemodialysis catheters in patients requiring hemodialysis prior to placement and/or maturation of an arteriovenous fistula (AVF) or graft (AVG). Methods: Between October 1998 and March 2000, all patients requiring hemodialysis access placement were prospectively evaluated with duplex ultrasound for status of upper extremity vessels and central veins prior to selection of a permanent access site. When interim tunneled and cuffed hemodialysis catheters were required, they were placed on the side contralateral to proposed AVF/AVG placement. No catheters were placed without initial vascular screening. The study group was compared to historical controls during a similar period (April 1997 through September 1998) when no vascular screening was performed. Results: During the study period, 234 screening duplex ultrasound examinations were performed in 244 patients. Ten patients required no screening prior to access site placement. Overall, 353 catheters were placed, 243 (69%) on the right side and 110 (31%) on the left side. During the control period, 394 catheters were placed in 255 patients, 306 (78%) right-sided and 88 (22%) left-sided. The increase in left-sided catheters with ultrasound screening and careful planning for future access sites was significant (p<0.01). Conclusion: Vascular-screening-directed catheter placement significantly alters the side of catheter placement when compared to a management protocol without prior screening. Such screening helps identify the side of permanent access placement, while directing interim catheters to the contralateral side such that central veins may be preserved for permanent access.     

Hemodialysis catheters and ports

Percutaneous placement of cuffed tunneled catheters for hemodialysis access has become a firmly established method of providing vascular access to patients with end-stage renal disease. Considerable evidence supports the right internal jugular vein as the preferred site for catheter insertion. The use of real-time imaging using both ultrasound and fluoroscopy permits simple, safe, and effective placement of the catheter for hemodialysis. The use of these imaging techniques has significantly reduced the number of and severity of complications associated with catheter placement. A specific method of placement is described including variations for specific catheter types. The new subcutaneous port as an alternative to the cuffed tunneled catheter appears to provide another option for vascular access; preliminary data suggests higher flow rates and lower infection rates compared with externalized cuffed tunneled catheters. Finally, the criteria for obtaining training and proficiency in placement of cuffed tunneled catheters are outlined.     

A prospective, randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunneled chronic venous access catheter infections in cancer patients.

OBJECTIVE: This study was performed to evaluate the effect of a silver-impregnated cuff on the incidence of catheter-related bacteremia/fungemia or tunnel tract infection in cancer patients with chronic dual-lumen tunneled venous access catheters. SUMMARY BACKGROUND DATA: Infection is a frequent and potentially life-threatening complication of tunneled chronic cuffed silastic central venous access catheters in cancer patients. Recent experience with antimicrobial silver-impregnated cuffs placed on nontunneled percutaneously inserted central venous catheters suggests that such a cuff may render the catheter less prone to infection. METHODS: The authors prospectively randomized 200 cancer patients to receive either a dual-lumen 10 French tunneled cuffed silastic central venous access catheter or the same catheter with a second more proximal subcutaneous silver-impregnated cuff. All patients then were followed prospectively for infectious morbidity until the device was removed or the patient died. RESULTS: The hazard rate for infection/day (95% confidence limits) was 0.0022 (0.0015 to 0.0030) for standard catheters compared with 0.0027 (0.0019 to 0.0037) for catheters with silver-impregnated cuffs (p = not significant). Regression analysis of infection-free interval of both catheter types shows no difference over the lifetime of catheter as well as the over the first 48 days after insertion. CONCLUSIONS: The study indicated no effect of a silver-impregnated cuff in decreasing the incidence of catheter-related bacteremias/fungemias, tunnel infections, or the spectrum of causative microorganisms involved in cancer patients with tunneled chronic venous access catheters.     

Jugular vein-mammary artery fistula after catheterism for hemodialysis: case report

The demographic characteristics of hemodialysis (HD) patients increase the need for the tunneled cuffed permanent catheter (TCC) as a definitive vascular access (VA) for HD. The internal jugular vein is increasingly being used as a route for TCC or temporary catheter placement and can be associated with serious complications. Among them other authors have described arteriovenous fistula (AVF) creation between the common carotid artery and the right jugular vein. We describe a case of an AVF between the right internal jugular vein and the right internal mammary artery. The fistula was detected during the TCC placement in a patient who underwent several jugular and subclavian catheterisms for HD in her clinical history.     

Central venous catheters as a vascular access modality for pediatric hemodialysis

Background The use of hemodialysis catheters is an essential component of dialysis practice. Children are particularly likely to require multiple courses of dialysis over their lifetime, hence the repeated need for vascular access. These catheters remain a significant source of morbidity and mortality. Methods All catheters inserted for hemodialysis at the Center of Pediatric Nephrology and Transplantation, Cairo University over a period of 40 months were studied. Patient data as well as data of catheter insertion, dwell, cause of removal and complications were reported. Results A total of 195 uncuffed central venous catheters were used for temporary access in 131 patients for a mean duration of 35.7 days. Of attempted insertions, 87.4% achieved successful access, of which 56% remained for the required period, 8.9% were accidentally dislodged, and 35.1% were removed due to complications—mostly infection. The overall rate of possible catheter-related bacteremia was 9.6 episodes/ 1,000 catheter days. Infection increased with longer catheter dwell. Nineteen cuffed tunneled catheters were surgically inserted and used for up to 11 months (mean 117 days). Loss of these catheters was attributed mainly to infection (ten episodes) and catheter thrombosis (six episodes). During the study, 317 femoral catheters were inserted. Conclusion Uncuffed central venous catheters are both needed and useful for short-term hemodialysis. Vascular access for extended durations may be provided by cuffed tunneled catheters. Infection is the major serious concern with both uncuffed and cuffed catheters.     

Ultrasound-guided cannulation and endocavitary electrocardiography placement of internal jugular vein catheters in uremic patients: the importance of routine chest X-ray evaluation

The NKF-DOQI guidelines recommend performing chest-X-ray(CXR) after subclavian and internal jugular vein insertion prior to catheter use. This is to exclude complications such as a pneumothorax before starting hemodialysis. Indication of a central venous dialysis catheter was based on the historic use of the subclavian vein for placement of these catheters and upon the reported incidence of pneumothorax after this approach of between 1% to 12.4%. In contrast, the incidence of these complications using the internal jugular vein (IJV) is much lower (< 1%). We report our experience in ultrasound-guided cannulation of the right IJV for dialysis vascular access in 527 uremic patients and central catheter placement by endocavitary electrocardiography (EC-ECG). Fluoroscopy was not utilized. In the first hundred cases, all patients underwent CXR. Subsequently, because of total absence of complications and catheter tip malpositioning, the CXR control was carried out only in selected cases (repeated cannulation of the jugular vein or absence of P wave). We believe that only in selected cases should a pCXR be performed before starting hemodialysis sessions, and that our method using the right IJV, ultrasound-guided puncture of the vessel, and catheter placement by EC-ECG is a safe and simple technique that avoids the need for CXR control.     

Vascular access and increased risk of death among hemodialysis patients

BACKGROUND: Hemodialysis with a venous catheter increases the risk of infection. The extent to which venous catheters are associated with an increased risk of death among hemodialysis patients has not been extensively studied. METHODS: We conducted a retrospective cohort study of 7497 prevalent hemodialysis patients to assess the association between dialysis with a venous catheter and risk of death due to all causes and to infection. RESULTS: A tunneled cuffed catheter was used for access in 12% of the patients and non-cuffed, not tunneled catheter in 2%. Younger age (P = 0.0005), black race (P = 0.0022), female gender (P = 0.0004), short duration since starting dialysis (P = 0.0003) and impaired functional status (P = 0.0001) were independently associated with increased use of catheter access. The proportion of patients who died was higher among those who were dialyzed with a non-cuffed (16.8%) or cuffed (15.2%) catheter compared to those dialyzed with either a graft (9.1%) or a fistula (7.3%; P < 0.001). The proportion of deaths due to infection was higher among patients dialyzed with a catheter (3.4%) compared to those dialyzed with either a graft (1.2%) or a fistula (0.8%; P < 0.001). The adjusted odds ratio (95% CI) for all-cause and infection-related death among patients dialyzed with a catheter was 1.4 (1.1, 1.9) and 3.0 (1.4, 6.6), respectively, compared to those with an arteriovenous (AV) fistula. CONCLUSION: Venous catheters are associated with an increased risk of all-cause and infection-related mortality among hemodialysis patients.     

Conversion of temporary hemodialysis catheters to permanent hemodialysis catheters: a retrospective study of catheter exchange versus classic de novo placement

Many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) catheters to long-term or permanent catheters. However, since vascular access sites are at a premium in the dialysis patient, it is important to preserve existing central venous catheters and conserve future access sites. In this retrospective study, data from 94 patients referred to interventional radiology for placement of long-term, tunneled HD catheters between July 2001 and September 2002 were reviewed. The study group consisted of 42 patients in whom the temporary catheter was exchanged for a peel-away sheath and a tunneled catheter inserted using the existing venous access site. The control group included 52 patients who received traditional de novo placement of permanent catheters. Based on available follow-up data, we report a 100% technical success rate, with 72% patency at 30 days in the study group (n = 32; mean age 58 years). By comparison, de novo catheter placement (n = 35; mean age 59 years) yielded a 100% technical success rate, with 83% patency at 30 days. The overall infection rate was 0.30 per 100 catheter-days (total 3036 catheter-days) and 0.36 per 100 catheter-days (total 3295 catheter-days), respectively (chi2 = 0.64, p > or = 0.05). There was no incidence of exit site infection, tunnel infection, or florid sepsis in either group. Likewise, no stenosis or bleeding complication was noted. Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.     

Outcomes of tunneled femoral hemodialysis catheters: comparison with internal jugular vein catheters

BACKGROUND: Tunneled femoral vein dialysis catheters are used as a last resort when all other options for a permanent vascular access or thoracic central vein catheter have been exhausted. There is little published literature on the complications or outcomes of tunneled femoral catheters. METHODS: Using a prospective, computerized vascular access database, we identified all tunneled femoral dialysis catheters placed at the University of Alabama at Birmingham during a five-year period. The clinical features, catheter patency, and complications in these patients were compared to those observed in a group of sex-, age-, and date-matched control patients with tunneled internal jugular vein dialysis catheters. RESULTS: During the study period, 27 patients received a tunneled femoral dialysis catheter, accounting for 1.9% of all tunneled catheters placed. Only 7 patients (26%) were able to convert to a new permanent dialysis access. The primary catheter patency (time from placement to exchange) was substantially shorter for femoral catheters than for internal jugular dialysis catheters (median survival, 59 vs. >300 days, P < 0.0001). Infection-free survival was similar for both groups (P= 0.66). Seven patients with femoral catheters (or 26%) developed an ipsilateral deep vein thrombosis, but catheter use was possible with anticoagulation. CONCLUSION: Tunneled femoral dialysis catheters have a substantially shorter primary patency, but a similar risk of catheter-related bacteremia, as compared with internal jugular vein catheters. An ipsilateral lower extremity deep vein thrombosis occurs commonly after placement of a femoral dialysis catheter, but does not preclude continued catheter use.     

深静脉长期留置导管与动静脉内瘘在血液透析患者中的应用比较

目的比较深静脉长期留置导管与自体动静脉内瘘作为血管通路的透析充分性及并发症,探讨深静脉长期留置导管在血液透析中的意义。方法选择徐州市中心医院肾脏内科新建立长期留置导管患者24例（导管组）,新建立自体动静脉内瘘患者30例（内瘘组）,随访36-40个月,比较2组患者年龄、最大血流量及观察终点前1个月内射血分数（EF）、尿素清除指数（Kt／V）以及观察期间2组感染、血栓、死亡发生情况。结果导管组使用时间（30．2±7．0）个月,内瘘组使用时间（37．9±2．4）个月;导管组最大血流量、通路使用时间、Kt／V值均低于内瘘组,但差异无统计学意义（P〉0．05）;导管组年龄、EF值高于内瘘组,差异无统计学意义（P〉0．05）;导管组感染率、血栓发生率及病死率均高于内瘘组（P〈0．05）。结论导管组与内瘘组均可达到充分透析,虽然导管组感染率和血栓发生率较高,深静脉长期导管仍为维持性血液透析患者建立血管通路的良好替代。     

单中心血液透析患者血管通路使用情况分析

目的 探讨维持性血液透析患者血管通路的使用情况,为进一步规范化选择建立和使用维护血液透析血管通路提供依据.方法 采用单中心横断面调查及回顾性分析的研究方法,统计分析2012年1月至2012年12月兰州军区兰州总医院血液净化中心新入血液透析患者156例与维持性血液透析患者120例人口统计学资料、血管通路类型,并对自体动静脉内瘘与长期血液透析导管患者原发病种类进行对比分析.结果①首次血液透析血管通路为临时血液透析导管的占84％,成熟的自体动静脉内瘘占16％,无长期血液透析导管;②长期维持性血液透析患者血管通路为自体动静脉内瘘251例（占90.9％）,长期血液透析导管14例（占5.1％）,动静脉直接穿刺及其他11例（占4.0％）,无动静脉移植血管内瘘.自体动静脉内瘘吻合血管依次为桡动脉-头静脉占96％,桡动脉-贵要静脉占2％,尺动脉-贵要静脉占2％;自体动静脉内瘘瘘管吻合方式端侧吻合占54％,端端吻合占46％,无侧侧吻合.自体动静脉内瘘发生并发症17例,血栓12例（占并发症总例数70.6％）,其余依次为缺血（占10.2％）,狭窄（占10.2％）,肿胀手（占0.9％）.长期导管年平均感染率为0.1次/1 000导管日.结论①新入血液透析患者中,选择临时血液透析导管比例较大,预先行动静脉内瘘血管通路准备的血液透析患者比率仍较低,但较前明显提高,需要积极专科宣教提高终末期肾脏疾病患者认识和依存性;②维持性血液透析患者自体动静脉内瘘使用率与文献报道接近,但尚无移植物和人造血管内瘘病例,尚有一定比例的患者直接选择穿刺;③自体动静脉内瘘术失败与年龄无关,基础疾病心血管疾病糖尿病等及反复血管穿刺是自体动静脉内瘘术失败的主要原因.     

A modified supraclavicular approach for central venous catheterization by manipulation of ventilation in ventilated patients

Background: Because of overuse and multiple implantations of hemodialysis catheters through internal jugular or subclavian vein (SCV) in patients with chronic hemodialysis, these veins often become stenotic or occlude, therefore necessitating alternative access. We introduce a new technique in ventilated patients for placement of tunneled cuffed chronic hemodialysis catheter: modified supraclavicular approach by cease of ventilation. Methods: Patients who received implantation of the tunneled cuffed chronic hemodialysis catheters by supraclavicular approach were collected from February 2003 to July 2005. Right subclavian, right innominate or left SCVs were accessed through the supraclavicular approach for catheter insertion. The procedures were performed by certificated anesthesiologists. The following parameters were recorded: co‐morbidities, laboratory examinations before the procedure, method for catheterization, duration of procedure, complications related to catheterization and long‐term outcome of hemodialysis catheters. Results: Eleven catheters were inserted in nine patients (two patients received twice) by supraclavicular approach during this period. All patients were mechanically ventilated and these catheters (seven at right and four at left) were implanted using the modified supraclavicular approach with lung deflation during venipuncture, advance of guidewire, and insertion of catheter. There were no procedural complications. The average duration of whole procedure was 36.6 minutes (30–45 minutes) and the mean catheter survival days were 62.1 days (13–152 days). The estimated duration was <1 minute of each period of lung deflation. There were no desaturation or pneumothorax during the whole procedure. Conclusion: The modified supraclavicular approach with lung deflation for tunneled cuffed chronic hemodialysis catheter in ventilated patients is at least as effective as traditional approach and can be easily performed by surgeons as well as experienced physicians. Based on the results, this simplified technique using lung deflation may be particularly useful to decrease procedural complications.     

Conversion of temporary hemodialysis catheters to tunneled hemodialysis catheters

PURPOSE: To determine the feasibility and clinical outcomes of conversion of temporary to tunneled hemodialysis catheters using the same venous insertion site. METHODS: Data from 42 patients with existing temporary hemodialysis catheters referred for placement of tunneled hemodialysis catheters were retrospectively reviewed. In these patients, the temporary catheter was exchanged for a peel-away sheath, and a tunneled catheter was inserted using the existing venous access site. Technical success, procedural complications, and clinical outcomes were evaluated. Hemodialysis records were reviewed to assess catheter patency during a 30-day follow-up period. RESULTS: The study group consisted of 20 males and 22 females (mean age: 58 years). All 42 temporary catheters were successfully converted to tunneled hemodialysis catheters without immediate procedure-related complications. Follow-up data were available for 32 patients (total: 3038; median 71 catheter days). Nine catheters were removed for infection, yielding a catheter infection rate of 0.30/100 catheter days; three catheters were removed for blood flow <200 ml/min. 13 patients had catheters removed when catheters were no longer needed. Three patients died with working catheters. The patency rate was 72% at 30 days, with four catheters functioning at the end of the study period. CONCLUSION: Conversion of a temporary hemodialysis catheter to a tunneled hemodialysis catheter using the same venous insertion site is a safe procedure that avoids complications associated with venotomy and allows conservation of other central venous access sites. Patency and infection rates in these catheters are comparable to several studies of catheter exchange and de novo placement of tunneled hemodialysis catheters.     

Bacterial colonization of chronic hemodialysis catheters: Evaluation with endoluminal brushes and heparin aspirate

Tunneled catheters serve as interim access during maturation of a graft or fistula, or as a permanent vascular access in those patients who have exhausted their traditional access sites. However, bacteremia rates are high in patients with chronic catheters and indiscriminate removal of catheters during bacteremia increases morbidity and costs. A method to identify whether a catheter was colonized with the offending bacteria, without requiring catheter removal is desirable. We compared endoluminal brushing and heparin aspiration, to detect catheter colonization, in 24 asymptomatic patients undergoing elective tunneled hemodialysis catheter removal. The incidence of catheter colonization was highly correlated with catheter duration of inverted exclamation markY 30 days (p=0.03). Staphylococcus epidermidis represented 68% of the organisms isolated. No other organism accounted for more than 7% of the total. Fifteen (62.5%) of the 24 catheters had positive cultures. Eleven of the catheters were positive by culture of heparin aspirate and eight were positive by endoluminal brushing. Only four of the catheters were positive by both methods. The arterial lumen was more likely to have positive cultures than the venous lumen using either method. In this prospective investigation of tunneled hemodialysis catheters in asymptomatic patients we have demonstrated that a heparin aspirate sample is more likely to detect catheter colonization than a sample obtained using an endoluminal brush. Furthermore, 75% of catheters present for more than 30 days were colonized. Further study is needed to determine if the heparin aspirate method could be used in patients with bacteremia to accurately identify catheters that need removal.     

The application status of vascular access at initiation of hemodialysis in patients with end stage renal disease—a single center study

Objective To investigate the types and outcome of vascular access in patients with end stage renal disease (ESRD) initiated hemodialysis (HD), and provide the basis for advancing the proportion of planned HD with arteriovenous fistula (AVF). Methods Clinical data, vascular access types at the initiation of HD, the outcomes of all types of dialysis access and the conversion of renal replacement therapy of ESRD patients who initiated HD in the first affiliated hospital of zhejiang university between January 2009 and December 2011 were retrospectively studied. Results A total of 836 patients were included in our study. Among them 510 were males and 326 were females. The average age was (49.77±17.65) years old. The major primary diseases were primary glomerular disease (72.73%), diabetic nephropathy (11.60%)and hypertensive nephrosclerosis (3.95%). Only 73 patients (8.73%) used AVF as the vascular access at the initiation of HD, another 763 patients (91.27%) used central venous catheter. Six months after the start of dialysis, 542 patients (81.5%) had used AVF as permanent vascular access, 123 patients (18.5%)had used the tunneled cuffed catheter, 54 patients had received a transplant and 55 patients had converted to peritoneal dialysis. The results of logistic regression analysis suggested that being male, patients from outside hangzhou and patients whose glomerular filtration rate were lower than 5 ml•min-1•(1.73 m2)-1 were the risk factors of using central venous catheters at the initiation of HD. Conclusions Only a minority of patients used AVF at the initiation of HD, but most of the other patients switched to AVF within the following six months. Increasing the proportion of AVF as the vascular access of planned HD is still our current goal.     

Outpatient percutaneous central venous access in cancer patients

A 1-year experience of percutaneous subclavian catheterization in outpatients with cancer was reviewed to document reliability, safety, and cost. There were 763 catheter insertions attempted with prospective documentation of complications in 664 consecutive patients. Catheter insertion was successful in 722 attempts (95%). There were only 13 pneumothoraces (2%). Thirty catheters required repositioning (4%). The average catheter duration was 191 days (range: 0 to 892 days). Fifty-six catheters (8%) were removed because of suspected infection. Documented catheter sepsis occurred in 21 patients (3%); catheter site infection occurred in 8 patients (1%). Thus, only 0.22 infections per catheter year occurred during this 382 catheter-year experience. The estimated cost of catheter insertion was $562, which is one-third the estimated cost for tunneled catheters ($1,403) and for reservoir devices ($1,738). In our experience, percutaneous subclavian catheterization is a reliable, cost-effective method compared with tunneled or reservoir devices, with an equivalent incidence of catheter-related infections. The cornerstone of our success with this program is a staff dedicated to catheter care and intensive patient education. In centers where a large number of patients require central venous access, percutaneous catheterization should be the technique of choice.     

Surface‐Treated Catheters—A Review

Almost 30% of prevalent hemodialysis patients use catheters for vascular access although outcomes are superior with the use of either an arteriovenous fistula or a synthetic graft. Catheter complications are a major cause of morbidity and mortality for hemodialysis patients and increase the burden on the health care system. Surface‐treated catheters have been developed to combat the three most common causes of catheter failure: infection, fibrin sheath formation, and thrombus formation. Two types of catheter surface treatments are available: antimicrobial coatings and antithrombotic coatings. Surface treatment of central venous catheters with antimicrobial materials reduces both bacterial colonization and the incidence of catheter‐related bacteremia in critical care patients by 30–50%. Antithrombotic coatings reduce platelet adhesion, inhibit the inflammatory response, and reduce thrombus formation on coronary stents, ventricular assist devices, central venous catheters, and vascular grafts. However, few reports on the use of surface‐treated catheters in the chronic hemodialysis patient population exist. At the present time, it is difficult to justify the increased cost of surface‐treated catheters for chronic hemodialysis in the absence of clinical data demonstrating that they reduce catheter‐related complications in this patient population.     

Central venous dialysis access: experience with a dual-lumen, silicone rubber catheter

The central venous dialysis catheter has gained wide acceptance for short-term hemodialysis with the realization of the need to spare peripheral extremity vessels for the creation of more durable internal arteriovenous fistulas. The Hemocath (Quinton Instrument Co., Seattle, Wash.), a soft, silicone rubber, double-lumen central venous dialysis catheter, was introduced as a permanent access device in 1984. A prospective evaluation of 53 catheters placed in 51 patients over a 9-month period is presented. Forty-nine catheters were placed for temporary access and four were placed for permanent access. All 53 catheters were discontinued after functioning an average of 63.9 days (range, 5 to 324 days). No major complications occurred during insertion or on dialysis. One catheter fragmented during removal and was retrieved in the operating room. Infection led to the removal of 17 catheters (34.7%). Thrombosis occurred in 11 catheters and was the cause of removal in two (4.1%). Excluding the two catheters that functioned at the time of the patient's deaths and those placed for permanent access, 91.5% of the catheters performed successfully as temporary accesses devices until permanent access sites were available for use. The catheter provided reliable, relatively safe, and easily maintained central venous access for hemodialysis.     

Using cuffed and tunnelled central venous catheters as permanent vascular access for hemodialysis: a prospective study

BACKGROUND: Adequate care of a hemodialysis patient requires constant attention to the need to maintain vascular access (VA) patency. VA complications are the main cause of hospitalization in hemodialysis patients. The native arteriovenous fistula (NAVF), synthetic arteriovenous grafts fistula (GAVF) and silastic cuffed central venous catheters (CVCs) are used for permanent vascular access (PVA). CVCs are primary the method of choice for temporary access. But using this access modality is increasing more and more for PVA in elderly hemodialysis patients and when other PVA is not possible. The primary aim of this study is to investigate survivals and complications of the CVCs used for long-term VA. METHODS: We prospectively looked at 92 CVCs (Medcomp Ash Split Cath, 14 FR x 28 cm (Little, M.A.; O'Riordan, A.; Lucey, B.; Farrell, M.; Lee, M.; Conlon, P.J.; Walshe, J.J. A prospective study of complications associated with cuffed, tunnelled hemodialysis catheters. Nephrol. Dial. Transplant. 2001, 16 (11), 2194-2200) with Dacron cuff) inserted in 85 (50 females, 35 males) chronic hemodialysis patients (the mean age: 56.6 +/- 14.1 years) from July 1999 to January 2002. The overall survival and complications were followed up. Furthermore, the patients were evaluated for demographic and clinical characteristics. Data were analysed by chi-square, Wilcoxon rank and Kaplan-Meier survival tests. RESULTS: The median duration of CVC survival was 289 days (range: 10-720). Eleven (11.9%) CVCs were removed due to complications. In 79 (92.9%) patients, 1, in 5 (5.8%) patients, 2 and in 1 patient, 3 CVCs were inserted. Of the 85 patients, 56 have CVCs functioning. In addition, 27 (31.76%) patients have CVCs functioning for over 12 months, 17 (20%) patients have CVCs functioning for 6 months. The total incidence of CVC related infections was 0.82 episodes/1000 catheter days. Besides, thrombosis was occurred in 10 (10.8%) CVCs. The most frequent indications for CVC removal were patient death (69.4%), thrombosis (16.6%) and CVC-related infections (13.8%). CONCLUSIONS: CVCs are primarily used for temporary access. But this study indicates that CVC may be a very useful alternative permanent vascular access for hemodialysis patients when other forms of vascular access are not available.     

Percutaneous, non-surgical placement of tunneled, cuffed, external jugular hemodialysis catheters: a case report

The right internal jugular vein is widely accepted as the vessel of choice for placement of long-term central venous catheters for hemodialysis. As vascular access sites become progressively depleted, alternate anatomic locations for access must be sought. We describe a non-surgical (fluoroscopy assisted, percutaneous) technique for placement of external jugular, tunneled, cuffed hemodialysis catheters, and provide long-term blood flow and dialysis adequacy data for EJV catheters.