Radiological placement of the AshSplit haemodialysis catheter: a prospective analysis of outcome and complications

Background. The AshSplit catheter has recently been introduced as an alternative permanent tunnelled haemodialysis catheter, combining ease of insertion with good long‐term patency and flow rates. Methods. Data were collected prospectively on all the long‐term tunnelled haemodialysis (AshSplit) cath...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2002-04, Vol.17 (4), p.614-619
Main Authors: Ewing, Fiona, Patel, Dilip, Petherick, Anne, Winney, Robin, McBride, Kieran
Format: Article
Language:English
Subjects:
access
Adult
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
catheters
Catheters, Indwelling - adverse effects
Emergency and intensive care: renal failure. Dialysis management
Female
haemodialysis
Humans
Intensive care medicine
long‐term
Male
Medical sciences
Middle Aged
Prospective Studies
Renal Dialysis - adverse effects
Renal Dialysis - instrumentation
split
Thrombosis - etiology
tunnelled
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Summary:Background. The AshSplit catheter has recently been introduced as an alternative permanent tunnelled haemodialysis catheter, combining ease of insertion with good long‐term patency and flow rates. Methods. Data were collected prospectively on all the long‐term tunnelled haemodialysis (AshSplit) catheters inserted radiologically between January 1998 and March 1999. Information was obtained regarding the initial insertion, ongoing catheter function and re‐intervention up to September 1999. Results. A total of 118 catheters were inserted in 88 patients (50 male), median (range) age 64 (20–86) years. Ultrasound guidance was used routinely and the right internal jugular vein was used in 80 (68%) cases. Initial complications occurred in 14 (11.9%) cases, which included local haemorrhage, carotid artery puncture, and air embolism. Infection occurred in 34% of catheters (2.4/1000 catheter days). Line thrombosis was documented in 20% (1.2/1000 catheter days). Satisfactory mean urea reduction ratio (URR) of 63 was obtained for all catheters. There were 47 re‐interventions, mainly for fibrin sheath stripping (34) and/or thrombectomy (25). Total catheter duration was 21600 days with a 1 month cumulative survival of 87% (Kaplan–Meier probability 85%). At the end of the study, 20 (17%) catheters were still functioning, 39 (33%) had been removed electively, and 22 (18%) patients had died with a functioning catheter in situ. Catheter infection was implicated in four deaths. Conclusions. Radiological insertion of the AshSplit catheter is well tolerated, providing reliable short‐ and long‐term dialysis access. Radiology also has a role in maintaining patency. As with all tunnelled catheters, infection remains a problem.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/17.4.614