Tunneled hemodialysis catheter survival: Comparison of radiologic and surgical implantation

Cuffed, tunneled hemodialysis catheters (caths) are often implanted in the operating rooms (OR) by surgeons or by interventional radiologists in radio logy suites (RS). Comparative outcome studies between OR and RS placed cath s are few and tend to favor the specialty of the authors. In this longitudi nal study, we monitored cath survival in patients while awaiting maturation of their fistulae, and compared outcomes between OR and RS placement. A to tal of 95 caths were placed in 50 patients between July 1996 and July 1999. Radiologically placed caths had a shorter primary patency duration than OR placed caths (80 +/- 40 days vs. 100 +/- 31 days, p = 0.04) and a lower pr imary patency rate at 120 days than OR placed caths (42% vs. 67%, p = 0.04) . Cumulative infection rate per 1,000 catheter days was higher in RS than O R cases (3.8 Vs 2.2, p = 0.09), whereas mean sepsis free duration was short er in RS than OR (60 +/- 45 days vs. 88 +/- 40 days, p = 0.02). The risk of infection was 1.7 times greater in RS than OR cases (chi-square = 6.4, p = 0.01). The RS placed caths also had a higher rate of primary nonfunction ( 31% vs. 8.3%, p = 0.04) and bleeding complications (42% vs. 17%, p 0.04), b ut significantly shorter procedure scheduling time than OR cases (1.1 +/- 0 .3 days vs. 2.5 +/- 0.6 days, p < 0.0001). In conclusion, radiologically pl aced caths seem to have higher rates of infection, bleeding, and functional failure but shorter scheduling time than surgically placed caths. Discussi ons are under way to improve the survival of RS placed caths at our affilia ted hospitals.