Moss A H, Vasilakis C, Holley J L, Foulks C J, Pillai K, McDowell D E
Department of Medicine, West Virginia University School of Medicine, Morgantown.
Am J Kidney Dis. 1990 Sep;16(3):211-5. doi: 10.1016/s0272-6386(12)81020-1.
We evaluated our experience over a 4-year period with a silicone dual-lumen catheter with a Dacron cuff (SDLCDC) to determine if the catheter represents an alternative to the polytetrafluoroethylene graft for long-term vascular access for hemodialysis patients. Records of 131 patients who used 168 catheters were reviewed for catheter function, duration of use, and occurrence and response to treatment of complications. Eighty-five percent of catheters functioned adequately until their use was no longer required or the end of the study. One-year catheter survival estimate was 65% and median survival estimate was 18.5 months. Mean blood flow rate achieved was 243 mL/min and recirculation was 7.5%. Exit-site infection occurred in 21% of patients and bacteremia in 12%. There were significantly more exit-site infections in diabetics than nondiabetics (33% v 11%, P less than 0.02). Exit-site infections resolved with parenteral antibiotic therapy in 90% and bacteremia in 25% of cases without catheter removal. Unresolved bacteremia was the most common cause of catheter removal and led to the loss of 7% of catheters. Thrombotic complications occurred in 46% of catheters. Urokinase instillation successfully treated catheter occlusion in 81% of cases. When urokinase instillation failed, streptokinase infusion restored catheter patency 97% of the time. The literature on the polytetrafluoroethylene (PTFE) graft was reviewed, and the SDLCDC was found to be similar to the graft in function, duration of use, and frequency of infectious and thrombotic complications. We conclude that the catheter represents an alternative to the graft for long-term vascular access in hemodialysis patients. Because of the frequent complications with both accesses, neither should be considered optimal. Further research is required to improve vascular access for patients in whom placement of an arteriovenous fistula is not possible.
我们评估了在4年期间使用带涤纶套的硅胶双腔导管（SDLCDC）的经验，以确定该导管是否可替代聚四氟乙烯移植物，为血液透析患者提供长期血管通路。回顾了131例使用168根导管患者的记录，以了解导管功能、使用时长以及并发症的发生情况和治疗反应。85%的导管功能良好，直至不再需要使用或研究结束。导管1年生存率估计为65%，中位生存期估计为18.5个月。平均血流量为243 mL/分钟，再循环率为7.5%。21%的患者发生出口部位感染，12%的患者发生菌血症。糖尿病患者的出口部位感染明显多于非糖尿病患者（33%对11%，P<0.02）。90%的出口部位感染经肠外抗生素治疗后痊愈，25%的菌血症病例在不拔除导管的情况下痊愈。未解决的菌血症是拔除导管的最常见原因，导致7%的导管丢失。46%的导管发生血栓并发症。81%的病例经尿激酶灌注成功治疗导管堵塞。当尿激酶灌注失败时，链激酶输注使导管通畅的成功率为97%。对聚四氟乙烯（PTFE）移植物的文献进行了回顾，发现SDLCDC在功能、使用时长以及感染和血栓并发症发生率方面与移植物相似。我们得出结论，该导管可替代移植物，为血液透析患者提供长期血管通路。由于两种通路都频繁出现并发症，因此都不应被视为最佳选择。对于无法进行动静脉内瘘置入的患者，需要进一步研究以改善血管通路。
