Background: The use of noncuffed nontunneled central venous catheters is a widely accepted method of gaining temporary vascular access for hemodialysis. Malfunction and bacteremia are the main factors limiting catheter survival. Methods: We followed up prospectively 73 hemodialysis catheters (HC) (40 internal jugular, 33 femoral) in order to establish factors influencing HC malfunction. HC malfunction was defined as a catheter that was unable to attain and maintain blood flows of at least 150 ml/min. 73 HC were used for a total 1,100 days. Results: HC malfunction occurred in 23 cases (31.51%) during the study period, giving an overall rate of 21 episodes per 1,000 catheter days at risk. An analysis revealed a higher risk of HC malfunction with the catheterization of the femoral vein compared to the internal jugular vein (hazard ratio (HR) 6.3; 95% confidence interval (CI) 5.3–7.3). After correction for confounding factors in multivariate Cox analysis, the site of the catheterization remained a statistically significant predictor of HC malfunction (HR 5.03, 95% CI 3.83–6.23). After the first week malfunction rate was 42 and 8% for femoral and internal jugular site, respectively (relative risk (RR) for malfunction 5.3 (95% CI, 2.5–8). After the second and third week, the incidence of malfunction was 51 and 14% for femoral and internal jugular vein, respectively (RR 3.6, 95% CI 2.2–5.1). Conclusions: Catheterization of the internal jugular vein is associated with longer catheter survival when compared to the femoral vein. Hemodialysis catheters should be placed, if possible, in internal jugular vein to prevent their premature malfunction.

Keywords:
Catheter malfunction, Central venous catheter, Hemodialysis, Temporary vascular access
1.
Hernandez D, Diaz F, Rufino M, Lorenzo V, Perez T, Rodriguez A, De Bonis E, Losada M, Gonzalez-Posada JM, Torres A: Subclavian vascular access stenosis in dialysis patients: Natural history and risk factors. J Am Soc Nephrol 1998;9:1507–1510.
2.
Almirall J, Gonzalez J, Rello J, Campistol JM, Montoliu J, Puig de la Bellacasa J, Revert L, Gatell JM: Infection of hemodialysis catheters: Incidence and mechanisms. Am J Nephrol 1989;9:454–459.
3.
Vanholder V, Hoenich N, Ringoir S: Morbidity and mortality of central venous catheter hemodialysis: A review of 10 years’ experience. Nephron 1987;47:274–279.
4.
Oliver MJ: Acute dialysis catheters. Semin Dial 2001;14:432–435.
5.
Blake PG, Huraib S, Wu G, Uldall PR: The use of dual lumen jugular venous catheters as definitive long term access for hemodialysis. Int J Artif Organs 1990;13:26–31.
6.
Oliver MJ, Edwards LJ, Treleaven DJ, Lambert K, Margetts PJ: Randomized study of temporary hemodialysis catheters. Int J Artif Organs 2002;25:40–44.
7.
Abidi SM, Khan A, Fried LF, Chelluri L, Bowles S, Greenberg A: Factors influencing function of temporary dialysis catheters. Clin Nephrol 2000;53:199–205.
8.
Shaldon S, Chiandussi L, Oliver MJ: Haemodialysis by percutaneous catheterization of the femoral artery and vein with regional heparinization. Lancet 1961;ii:857.
9.
NKF – DOQI clinical practice guidelines for vascular access. National Kidney Foundation – Dialysis Outcomes Quality Initiative. Am J Kidney Dis 1997;30:S150–S191.
10.
III: NKF – DOQI clinical practice guidelines for vascular access: Update 2000. Am J Kidney Dis 2001;37:S137–S181.
11.
Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN: Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: A prospective study. Kidney Int 2000;58:2543–2545.
12.
Kairaitis LK, Gottlieb T: Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant 1999;14:1710–1714.
13.
Traynor JP, Walbaum D, Woo YM, Teenan P, Fox JG, Mactier RA: Low-dose warfarin fails to prolong survival of dual lumen venous dialysis catheters. Nephrol Dial Transplant 2001;16:645.
© 2004 S. Karger AG, Basel
2004
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.