Surgical Management of Long-Term Central Venous Access in Uraemic Patients |
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Authors: | Donnelly P K; Hoenich N A; Lennard T W J; Proud G; Taylor R M R |
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Institution: | 1Department of Surgery, University of Newcastle upon Tyne UK
2Department of Medicine, University of Newcastle upon Tyne UK |
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Abstract: | Over a 5-year period, 19801985, 39 patients from a dialysispopulation of over 400 treated at this centre experienced majordifficulties in achieving adequate access for dialysis by conventionaltechniques (i.e. arteriovenous fistula or CAPD). This studyhas evaluated the long-term results of a new approach to circulatoryaccess, central venous catheterisation (CVC) for so called "highrisk" patients. CVC consists of inserting a single-lumen CAPD-typesilastic catheter into the right atrium via an external or internaljugular vein. Forty-seven catheters have been inserted into39 uraemic patients. All patients had failed on, or were unsuitablefor, conventional access to haemodialysis or CAPD. Ten patients(26%) had previous failed renal transplants. The median durationof catheter use was 7 months (range 160 months) and atotal of 6500 high-performance dialyses have been performedusing this technique. No patient has died of catheter-relatedproblems. The catheters were easily managed by nurses and welltolerated by the patients. The incidence of complications amongpatients was low: displacement (1), catheter thrombosis (2),skin exit-site infections (5), septicaemia (2). Central venouscatheterisation is a method of providing safe and reliable long-termvascular access which is immediately usable by high-risk patientswho have either failed on or are unsuitable for conventionalcirculatory access. |
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Keywords: | Haemodialysis Venous access Silastic catheter |
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