Budruddin M, Mohsin N, Amitabh J, Ehab M, Pramod K, Abbas P, Khalil M, Al-Lawati S
Department of Nephrology, Royal Hospital, Muscat, Oman.
Ren Fail. 2009;31(4):320-2. doi: 10.1080/08860220902780077.
Vascular access (VA) remains a thorny problem in at least some patients requiring hemodialysis (HD). When options like arterio-venous fistulae, grafts, and thoracic tunneled central catheters are exhausted, the patient survival becomes endangered. The choices left are limited to transplantation, peritoneal dialysis, and translumbar and femoral catheter insertion. The latter may, in many instances, be the only possibility. We report our experience in six patients, in whom all the vascular accesses were exhausted and transplantation or peritoneal dialysis could not be performed. Hence, we opted for femoral tunneled catheters (FTC) as a permanent and sole VA. The mean follow up period was 16 months (8-22 months). The mean age of the patients was 53.1 (35-72) years, the mean time on HD was 3.125 years (2-4.5), and the mean number of vascular accesses was 4.7 (4-7). In five patients, a Permcath (Quinton, Kendall) was inserted, and in one patient, a twin Tessio catheter (MPS, Germany) was inserted. All patients were administered aspirin or clopidogrel to prevent catheter thrombosis. Aseptic nursing procedures and personal hygiene were emphasized. All catheters were functional at 2.5 months. The mean blood flow was 220 mL/min (200-240 mL/min). One patient died at 18 months, with a functional catheter, due massive gastro-intestinal bleed not directly related to the FTC. In one patient, the site of the catheter was changed at 6.5 months due to accidental pulling of the catheter by the patient. One catheter flow became inadequate after nine months, which could be reversed with streptokinase or tissue plasminogen activator. One patient presented excessive bleeding at the time of insertion that was controlled after 25 minutes of compression against the pelvic bone. One patient presented deep vein thrombosis with catheter thrombosis that required reinsertion of the catheter three months later. In one patient, the catheter functioned for 19.5 months after insertion. It is noteworthy that no patient developed catheter-related septicemia. None of the patients developed late hemorrhage. We conclude that tunneled femoral catheter is a viable option in patients with exhausted VA. Strict aseptic nursing technique and personal hygiene are essential. A multi-center study would give a better insight into this type of VA.
血管通路（VA）在至少一些需要血液透析（HD）的患者中仍然是一个棘手的问题。当动静脉内瘘、移植物和经胸隧道式中心静脉导管等选择都用尽时，患者的生存就会受到威胁。剩下的选择仅限于移植、腹膜透析以及经腰和股静脉导管插入术。在许多情况下，后者可能是唯一的可能性。我们报告了6例患者的经验，这些患者的所有血管通路都已用尽，且无法进行移植或腹膜透析。因此，我们选择股静脉隧道式导管（FTC）作为永久性的唯一血管通路。平均随访期为16个月（8 - 22个月）。患者的平均年龄为53.1岁（35 - 72岁），平均血液透析时间为3.125年（2 - 4.5年），平均血管通路次数为4.7次（4 - 7次）。5例患者插入了Permcath（昆顿，肯德尔），1例患者插入了双腔Tessio导管（德国MPS）。所有患者均服用阿司匹林或氯吡格雷以预防导管血栓形成。强调无菌护理程序和个人卫生。所有导管在2.5个月时功能良好。平均血流量为220 mL/分钟（200 - 240 mL/分钟）。1例患者在18个月时死亡，导管功能正常，死于与FTC无直接关系的大量胃肠道出血。1例患者在6.5个月时因患者意外拉扯导管而更换了导管置入部位。1例患者在9个月后导管血流量不足，使用链激酶或组织型纤溶酶原激活剂后得以恢复。1例患者在插入时出现过度出血，对骨盆骨压迫25分钟后得到控制。1例患者出现深静脉血栓形成伴导管血栓形成，3个月后需要重新插入导管。1例患者的导管在插入后发挥功能19.5个月。值得注意的是，没有患者发生导管相关败血症。没有患者发生晚期出血。我们得出结论，隧道式股静脉导管对于血管通路已用尽的患者是一种可行的选择。严格的无菌护理技术和个人卫生至关重要。多中心研究将能更好地了解这种类型的血管通路。
