Aim: To determine risk factors for failure of temporary dialysis catheters,
we prospectively studied the outcome of 178 nontunneled dual lumen cathete
rs placed in 126 consecutive patients requiring treatment of acute renal fa
ilure (ARF) or end-stage renal disease (ESRD). Methods: Internal jugular (I
J) or subclavian (SC) catheters were used in 122 instances and femoral cath
eters were employed in 56. Results: IJ or SC catheters with tips in the rig
ht atrium or superior vena cava (n = 112) failed (defined as a blood flow <
250 ml/min) 17% of the time, compared with a 40% failure rate for catheter
s with more peripherally located tips (n = 10), p < 0.05 chi(2) testing. In
a multivariate analysis, use in ESRD and location peripheral to the SVC we
re risk factors for catheter failure. Use of one of three catheter brands w
as associated with a lower failure rate. Although mean venous pressures at
200 ml/min blood flow were higher in IJ or SC catheters that failed, the pr
esence of a high venous pressure, number of catheter uses, IJ vs. SC placem
ent, inpatient vs. outpatient status, and fresh venipuncture vs. placement
over a guidewire passed through a previous catheter did not predict cathete
r malfunction. With femoral catheters, the only risk factor for failure was
use in ESRD. Conclusion: Of the factors that can be influenced by placemen
t technique, catheter tip location is most important. Whether one catheter
brand is superior awaits further confirmation.