S-shaped-tunneled femoral catheter for permanent hemodialysis access

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S-shaped-tunneled femoral catheter for permanent hemodialysis access

Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 8

Abstract

Tunneled catheters as haemodialysis access which are inserted to the right atrium through the jugular vein are considered to cause bacteriemia less frequently as compared to that implanted through the femoral vein. The typical subcutaneous tunnel for jugular catheter is longer than femoral, and is caudally directed at the skin exit portion. The last prevents accumulation of epithelial debris and bacteria at the catheter outlet, which gives additional protection against bacteria migration along the subcutaneous tunnel. Here we report three patients with jugular vein occlusion secondary to previous catheterization, in which femoral catheter was placed as permanent hemodialysis access. For the standard exit site location would have allowed for only short subcutaneous tunnel, we gave it an additional curve to gain length. This modification resulted in an S-shaped caudally-oriented-orifice femoral catheter tunnel. The patients have been followed for 32 patientmonths (5, 13, and 14 month). During five month after placement no catheter migration, kinking, nor disfunction have been observed. None of the patients presented bacteriemia, exit or tunnel infection. The first incident of bacteriemia occurred after 32 patinetmonth of observation, which is similar incidence to that observed in peritoneal dialysis. The reason for termination of femoral cathter use was kidney transplantation (n=1), creation of a new a-v fistula, and death from endocarditis in a patient with critical aortic valve stenosis, after 12 month of otherwise uneventful use of femoral catheter. The causal relation between the catheter and endocarditis could not be excluded. We conclude that the S-shaped tunnel for femoral catheter is a safe option to ensure hemodialysis access in patients if artriovenous fistula or jugular catheter are not possible.

Authors and Affiliations

Ryszard Gellert, Tomasz Żelek, Marcin Czystowski, Dorota Daniewska

Keywords

Rekomendacje terapii inwazyjnej choroby grzybiczej u pacjentów z nowotworami hematologicznymi lub poddawanymi przeszczepieniu komórek krwiotwórczych

Inwazyjna choroba grzybicza (ang. invasive fungal disease – IFD) jest jednym z najpoważniejszych powikłań infekcyjnych i przyczyn śmiertelności u pacjentów z nowotworami hematologicznymi, ciężkimi zaburzeniami odporności...

EP ID EP53948
DOI -
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