The Application Of Long-term Cuffed Catheter Through The Internal Jugular Vein In Hemodialysis Patients

Part 1: The application of long-term cuffed catheter through the internal jugular vein in hemodialysis patientsObjective To analyze the causes of the using and the ending point of the long-term caffed cathers. Observing the incidence of the cather related complications in hemodialysis patients. Sumrizing our clinical experience with the treatment of the complications to extending the using term of the catheters.Methods From November 2005 to March 2007, 32 cases (34 times) were implanted dual-lumen cuffed catheters under local anesthesia in right jugular vein as blood access for hemodialysis, including 2 re-implanted patients.Among the 32 patients, 27 patients were female, 5 patients were male.Their ages were from 19 to 79 years old (58.22±13.78 years old on average). The patency of the catheters and their complications were observed. The ending point of the catheters were recorded.Results①Effective catheter usage: The survival period of the catheters were 256 months (7.53±4.4 months on average). Catheters survived over 12 months were observed in 4 cases, over 6 months in 11 cases, and less than 6 months in 12 cases, 6 cases were lost. At the ending point, the catheters had been used for 1 month to 12 months (5.94±4.40 months on average). Complications resulted the ending of the catheter usage included infection (in 1 case), catheter damage (in 1 case). There were 6 patients dead with good function catheters.②Catheter related complications: The incidence of hematoma was 8.82% (3/24) and that of catheter malposition was 5.88% (2/34). There was no hemothorax, pneumothorax, air embolism or veinous laceration. The incidence of the catheter related infection was 28.57% (8/28), 5 cases with inner catheter infection, they were all be treated successfully. There were 2 cases with tunnel infection, 1 case was treated with the combination of 2 kinds of antibiotics, and the skin above the tunnel be cutted open and drainaged in surgery way, then temperature returned to normal gradually. The other catheter was removed and re-implanted for uncontrolled infection. The incidence of catheter thrombosis was 14.29% (4/28), and the catheter had been used for a mean period of 2.75 months (1-6 months). Catheter patency was restored by urokinase infusion. Recurrent thrombosis occurred in 3 out of 4 catheters.Urokinase infusion followed by anticoagulation had prolonged the mean catheters'life time for 5.5 months (2.5-8 months).③Dialysis adequacy: The average URR was 71.5%±0.06%, KT/V was 1.52±0.19.Conclusion①The cuffed catheters were mainly used for the elderly patients and those whose peripheral circulation was too bad to establish fistula. The most common causes of the catheters'ending point was the elderly patients'high death rate from lots of the complications of their basic diseases.②The catheter thrombosis and the catheter related infections were the most common complications. Urokinase infusion followed by anticoagulation can significantly prolong the catheters'life time.Effective and long term usage of cuffed catheters in hemodialysis patients demand good catheter implanting technique and careful nursing which can also reduce infection rate.③The patients could get adequate dialysis by cuffed catheters. Part 2:Comparing the application of cuffed internal jugular vein catheters with femoral vein catheters and arteral-venous fistula in hemodialysis patientsObjective Observing the application of cuffed internal jugular vein catheters,femoral vein catheters and arteral-venous fistula in hemodialysis patients. To compare the advantages and disadvantages of the tree kinds of vascular acess.Methods We inserted 32 patients (34 times) with dual-lumen cuffed catheters in right jugular vein as permanent catheter group from November 2005 to March 2007.Femoral vein catheter group contained 40 patients and 35 patients in fistula group. The patency of the three vascular acess and their complications were observed. The ending point of them were recorded.Results①Effective catheter usage: The survival period of the permanent group (7.53±4.4 months on average) and the fistula group (8.48±3.63 months on average) were longer than that of femoral group (0.65±0.37 months on average) obviously (P<0.01).②Catheter related complications: The incidence of hematoma was 8.82% (3/24) in permanent group, 5%(2/40) in femoral vein group, 2.86% (1/35) in fistula group,there was no difference of the hematoma rate in the three groups (P>0.05). Infection rate of the two cathers group were all higher than that of the fistula group (P<0.01, P<0.05), no difference was found between the two catheters group (P>0.05). The incidence of the thrombosis in the fistula group were lower than both of the other two groups (P<0.01), the permanent group got lower rate than that of the femoral group (P<0.01).③Dialysis adequacy: The permanent group's Kt/V (1.52±0.19 on average) was higher than that of the femoral group (1.17±0.33 on average), and comparing with the fistula group (1.35±0.27 on average) no difference was found (P>0.05).Conclusion①The cuffed catheters were fit for those whose peripheral circulation was too bad to establish fistula. They also have the benefit of less complication and sufficient dialysis.②The catheter thrombosis and the catheter related infections were the most common complications.Besides diagnosing early and treating properly, the catheters also need the right position to intubate and nuring it well which can reduce the complications'rate gradually.