RIGHT ATRIAL CATHETERS - RELIABLE, IMMEDIATE AND DURABLE VASCULAR ACCESS FOR HEMODIALYSIS AND PLASMA-EXCHANGE

This paper prospectively evaluates 33 dual lumen, right atrial cathete rs inserted into either an external or internal jugular vein by open o peration in 29 patients, of whom 15 required haemodialysis and 14 requ ired temporary plasma exchange. The median (range) catheter survival i n the haemodialysis and plasma exchange groups was 108 days (7-334 day s) and 61 days (10-1 16 days), respectively. Life table analysis demon strated that overall catheter survival was 58% at 200 days. The main c auses of catheter failure were infection (four cases). poor flow (thre e cases) and accidental removal (one case). Another nine catheters wer e removed electively because of maturation of alternative methods of v ascular access (five cases), completion of plasma exchange treatment ( three cases), or successful renal transplantation (one case). Long-ter m silastic catheters, inserted into the right atrium via a jugular vei n, have distinct advantages over temporary subclavian vein catheters a nd external arteriovenous (AV) shunts; this form of access is the meth od of choice for haemodialysis and plasma exchange patients who requir e immediate and short- to medium-term vascular access.