Temporary vascular access for chronic haemodialysis: the Bahamian experience - abstract

ABSTRACT

We report our experience with the Shiley Double Lumen (SDL) and Permacath (PC) central venous access dialysis catheters during the period May 1986 to August 1988. The SDL Catheter study was confined to all patients selected for chronic dialysis and awaiting vascular access by a visiting access surgeon; patients receiving A-V shunts or peritoneal dialysis were excluded. PC was introduced in December, 1987 as an alternative to SDL. SDLs were inserted by standard percutaneous Seldinger technique in the dialysis unit, and PC via an internal jugular vein cutdown under local anaesthesia. Of the group of patients for chronic renal dialysis on temporary SDL access, the 21 patients who eventually had permanent vascular access were reviewed. No patients failing to achieve permanent vascular access died or were discontinued from dialysis due to complications of SDL cannulation. The 21 patients received 40 SDL cannulations (17 right subclavian vein, 21 left subclavian and 2 right femorals) for a total of 1,170 patient days and 393 haemodialysis episodes. SDLs were resited if there was sepsis, luminal thrombosis or clinical signs of subclavian vein thrombosis. One patient was carried for 215 days on SDL catheterizations. The longest site cannulated was 139 days. Seven patients received PC for a total of 720 patient days and 240 dialysis. Four catheters were removed after permanent access was established, 1 after sepsis and 2 remain in situ. We conclude that SDL and PC catheters can be safely used over an extended period for temporary dialysis on an outpatient basis without compromising future permanent access. This is particularly suited for geographical areas lacking a permanent vascular access surgeon (AU)