Successful use of central venous catheter as permanent hemodialysis access: 84-month follow-up in Lucania

Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in hemodialysis (HD) patients. These catheters serve an e ssential role in providing permanent access in subjects in whom all other a ccess options have been exhausted. The predominant complications are cathet er thrombosis, catheter fibrin sheating and infection. The aim of this stud y was to evaluate long-term survival and complications of permanent venous catheters (PVC) placed for the purpose of HD during the period from January 1992 to December 1998, at the Dialysis Units of Lucania (a southern Italia n region). A total of 98 PVC were placed in 88 patients during this period. The catheters used were of three types: (a) 72 VasCath Soft Cell catheters (Bard Instrument Company, Toronto, Ont., Canada); (b) 22 PermCath catheter s (Quinton Instrument Company, Seattle, Wash., USA), and ((c)) 4 Tesio cath eters (Bellco SpA, Mirandola, Italy). Survival curves of catheters were cal culated using the Kaplan-Meier product-limit estimator. The patient surviva l was 60% at the 78th month. Actually, 52 patients (27 males, 25 females) a re still alive: 15 (26.9%) of these patients have diabetes mellitus and ? h as been transplanted. The actuarial survival rate of PVC was 89% in the who le population studied and 82% in subjects alive after 84 months. Twenty-fiv e patients (28.4%) had PVC as the first reliable vascular access. Long-term complications occurred 27 times (1 episode every 44.81 month/ patient) as: breakage (3.1%); thrombosis (10.2%); displacement (2.0%); subcutaneous tun nel bleeding (3.1%); inadequate blood flow (7.1%), and infection (10.2%). I n conclusion, our data confirm that PVC might represent an effective long-t erm blood access route for HD. Again, PVC are getting the access of choice for selected patients (i.e., older subjects with cardiovascular diseases an d cancer patients) and are enjoying a dramatic increase in use for subjects who are terrified of repetitive venopuncture. Copyright (C) 2001 S. Karger AG, Basel.