LONG-TERM VASCULAR ACCESS FOR HEMODIALYSIS USING SILICON DUAL-LUMEN CATHETERS WITH GUIDEWIRE REPLACEMENT OF CATHETERS FOR TECHNIQUE SALVAGE

Difficulties in creating vascular access in patients on hemodialysis a re encountered in most dialysis centers, This is usually due to a lack of suitable peripheral vessels due to previous access surgery in pati ents on longterm hemodialysis, but also may be seen in some patients d e novo, particularly diabetics and patients with peripheral vascular d isease, Surgical techniques used to overcome this problem vary dependi ng on patient characteristics and, to a certain extent, on local exper tise/preference. We report our experience of using silicon dual-lumen hemodialysis catheters over a 3-year period; during this time, 54 cath eters were inserted into 32 hemodialysis patients, The indication for this procedure in 52 catheters (31 patients) was either exhausted vasc ular access or obvious difficulty identifying a suitable peripheral bl ood vessel, Of the catheters inserted, 20 were placed into subclavian veins by primary insertion (ie, patients did not have existing subclav ian catheter); 34 were replaced over a guidewire (a procedure used to allow technique salvage), The catheter survival rate was 72.7% at 90 d ays and 48.7% at 1 year, Corresponding rates at 90 days and 1 year for technique survival were 93.3% and 81.8%, respectively, The mean cathe ter and technique survival was 387 (95% confidence intervals [Cls], 27 3, 502) and 844 (95% Cls, 684, 1,005) days, respectively, Poor flow ac counted for 70.4% of catheter failures and, despite 18 episodes of cat heter-related sepsis, no catheters were lost due to infection, Factors identified as leading to reduced catheter survival were left-sided pl acement and catheter tip placement in the superior vena cava (as oppos ed to right atrial placement). We did not observe poorer survival or i ncreased sepsis in catheters replaced over a guidewire, and would advo cate this technique as a means of salvage in this group of patients. ( C) 1997 by the National Kidney Foundation, Inc.