Dose tunneling the temporary vascular access extend its lifetime?

ABSTRACT

It is important that a reliable vascular access or dialysis catheter be available for doing replacement therapy in cases with uremia syndrome. Life time of a temporary access depends on its location; overall its life time is 2 to 3 weeks for Jugular vein. Regarding short life time of these temporary accesses, it is necessary to find a clinical way to increase the life time of such accesses. It seems that tunneling the temporary uncuffed access, prolongs its life time and reduces its complications, as well as its cost. This study was a prospective clinical trial, which has been done on 30 cases with uremia syndrome without usable vascular accesses who were divided into two groups, randomly. Inclusion criteria were acute renal failure and end stage renal failure with different etiologies. All of them had got temporary vascular accesses because of their need to emergency hemodialysis. The type of used accesses, was used the same [arrow] in all cases. Patients were followed up once a week for checking the fistula or returning of kidney function in cases who had acute renal failure. Presence of inflammation, redness, pus formation, bleeding, and sutures of the entrance site were checked weekly. Life time of catheter was determined as the time of its insertion to the time of its extraction, in weeks. Data analysis was done by SPSS [version 12] and expressed by mean and variance. One case out of 30 selected subjects was excluded because of poor cooperation with clinicians. Thirteen females and 16 males [44.8% vs. 55.2%] were treated in two groups; the first group or tunneled group included 14 cases, and the second group, non-tunneled group, included 15 cases. Mean of age and length of neck showed no significant differences between two groups. Nine cases had fever before catheterization, however there wasn't any relationship between life time of catheter and fever in both groups [P=0.49 and 0.24, respectively]. In this research, the most common reason for releasing the catheter in both groups was the fever due to catheter related infection, only [78.6% in tunneled group and 80.00% in non-tunneled group]. Mean life time of catheter in tunneled group was 6.71 +/- 0.9 weeks and, in cases of non-tunneled group it was 4.53 +/- 0.8 weeks; this difference was statistically significant between two groups [pvalue= 0.0017]. Subcutaneous tunneling the temporary vascular access can extend the lifetime of catheter and reduce its subsequent dangers and related costs due to repeated catheterization, with respect to routine method: