RESUMEN
Central venous catheters for hemodialysis are very useful as blood accesses when arteriovenous fistulas [AVF] are not available. The aim of this study is to analyse the clinical impact of internal jugular catheters [IJC] in hemodialysed patients and to assess their economic consequences. It is a prospective study realised from July 1998 to March 2002 including 533 hemodialysed patients without functional AVF: 280 males and 253 females aged between 17 and 87 years [mean age: 54.1 +/- 15 years]. Single lumen polyurethane Vygon were used. All catheters were placed using Seldinger procedure and the posterior route of Jernigan which is more comfortable for patient. Indications of IJC placement were new hemodialysed patients without AVF in 73.5% cases and no functional AVF in 26.5% cases. During the period of the study, IJC was placed in 533 patients. We failed to place the IJC at the first attempt in 42 patients but we succeded in placing it on the controlateral side. During IJC placement, we observed 50 [9.4%] cases of accidental puncture of carotid artery. The median duration use of IJC was 41 days [extreme: to 413 days]. IJC were removed mainly because of the use of AVF in 469 [88%] cases and the catheter infection in 41[77%] cases. Bacteriological analysts were made only for 25 patients: staphylococci were identified in 16 cases and catheter cultures were negative in the 9 other cases. All patients were treated with antibiotics. Outcome was favourable for 39 of them and we had 2 deaths by septicemia. The IJC cost was 44,287 Tunisian Dinars [DT] coresponding to 31.633 ' including 10125 DT [7,232'] for infectious treatment. The use of IJC is frequent in our center with a high rate of infectious complications which increased the hemodialysis cost. The realisation of AVF. in patients with chronic renal failure before the beginning of hemodialysis, is the best way to limit the use of catheters