Cuffed-tunneled femoral catheter for long-term hemodialysis

Background: Hemodialysis access is a challenging problem in patients with e xhausted dialysis access sites of their upper extremities. Femoral arterio- venous polytetrafluoroethylene (PTFE) graft is often necessary. The safety and efficacy of cuffed tunneled catheters at the femoral site for long-term hemodialysis has not been extensively studied. Methods: We inserted 14 cuffed-tunneled femoral catheters in 11 hemodialysi s patients with exhausted dialysis access sites of their upper extremities. Access survival and risk of infection were compared with the 11 femoral PT FE grafts in 10 patients of our center during the same period. The choice o f dialysis access was determined by the individual nephrologist. Access sur vival was defined as the achievement of a blood flow rate of at least 180 m l/min. Results: The median survival of tunneled femoral catheter and PTFE graft we re 166 days and 560 days respectively (log-rank test, p = 0.33). Seven of t he 14 tunneled femoral catheter remained in use 3 months after insertion. T he incidence of catheter- or graft-related infection was 0.38 and 0.23 epis odes per 100 catheter/graft days for tunneled femoral catheters and PTFE gr aft respectively (p = 0.6). Five tunneled catheters and one PTFE graft had to be removed because of infection. Blood flow rates achieved were comparab le between tunneled femoral catheter and PTFE graft. Conclusions: Our preliminary data suggest that the cuffed tunneled femoral catheter has reasonable access survival and an acceptable risk of infection . It may provide a safe and effective access for long-term hemodialysis pat ients with exhausted access in their upper extremities, especially high ris k patients who are not suitable for femoral PTFE graft creation.