Radiological placement of the AshSplit haemodialysis catheter: a prospective analysis of outcome and complications
Radiological placement of the AshSplit haemodialysis catheter: a prospective analysis of outcome and complications
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DOI：
10.1093/ndt/17.4.614
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发表时间：
2002-04-01
影响因子：
6.1
通讯作者：
McBride, K
中科院分区：
文献类型：
--
作者：
Ewing, F;Patel, D;McBride, K
背景AshSplit导管最近已被引入作为替代永久性隧道血液透析导管，结合插入情况，具有良好的长期通畅性和流速。前瞻性收集了1998年1月至1999年3月期间通过放射学插入的所有长期隧道式血液透析（AshSplit）导管的数据。获得的信息包括最初的插入、导管功能和再介入直至1999年9月。共有118导管插入88例患者（50名男性），中位（范围）年龄64（20 - 86）岁。常规使用超声引导，80例（68%）使用右颈内静脉。14例（11.9%）患者发生了初始并发症，包括局部出血、颈动脉穿刺和空气栓塞。34%的导管发生感染（2.4/1000导管日）。20%（1.2/1000导管日）记录了管路血栓形成。所有导管的平均尿素减少率（URR）均为63。有47例再次介入，主要是纤维蛋白鞘剥脱术（34例）和/或血栓切除术（25例）。总导管持续时间为21600天，1个月累积生存率为87%（Kaplan-Meier概率为85%）。在研究结束时，20例（17%）导管仍在工作，39例（33%）被选择性取出，22例（18%）患者在原位导管工作时死亡。导管感染与4例死亡有关。AshSplit导管的放射学插入耐受性良好，可提供可靠的短期和长期透析通路。放射学也在维持通畅性方面发挥作用。与所有隧道导管一样，感染仍然是一个问题。
Background. The AshSplit catheter has recently been introduced as an alternative permanent tunnelled haemodialysis catheter, combining case 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.