| Theme |
Progresses and Problems in Vascular Access for Hemodialysis |
| Title |
Long term central venous hemodialysis catheters |
| Author |
Nakanobu Azuma |
Department of Surgery, Toukatsu-Clinic Hospital |
| Author |
Takashi Uchino |
Department of Surgery, Toukatsu-Clinic Hospital |
| [ Summary ] |
Recently, cuffed catheters have been used temporarily in vascular access trouble cases. When there is no other option, the cuffed catheter should be selected carefully as a continual vascular access method because of the high associated risks. The DOQI guidelines are as follows: "Tunneled cuffed venous catheters are the method of choice for temporary access of longer than three weeks' duration. (They also are acceptable for access of shorter duration.) In addition, some patients where we have exhausted all other access options require permanent access via tunneled cuffed catheters. For patients who have a primary AV fistula maturing but need immediate hemodialysis." In our opinion, theprimary indication for this treatment is defined ascases with severe peripheral arterial obstructive disease, chronic heart failure or chronic hypotension. From 2000 to 2007, we inserted 90 tunneled cuffed catheters in 82 patients. In forty six cases (58%) it was difficult to achieve vascular accesses in anyother fashion. Catheters were replaced in 8 casesand other vascular accesses methods were appliedin 7 cases. Infection occurred in 8 cases. Fifty one patients died and 25 catheters are still functioning. Itis suggested that infection, thrombosis and weakening of the catheter material are major problems. |