Factors influencing function of temporary dialysis catheters

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.