Kovač Janko, Premru Vladimir, Buturović-Ponikvar Jadranka, Ponikvar Rafael
Department of Nephrology, University Medical Center, Ljubljana, Slovenia.
Ther Apher Dial. 2011 Jun;15(3):311-4. doi: 10.1111/j.1744-9987.2011.00957.x.
Two single-lumen, noncuffed catheters in the same jugular vein have been used as preferred vascular access in our hemodialysis (HD) and apheresis patients in past years. The aim of this retrospective study was to analyze the clinical outcome of such a vascular access and the reasons for catheter removal. In 129 adult patients, aged 69 ± 13 years, 56% males, treated by HD (121 patients) or apheresis (8 patients), two single lumen, pre-curved 8 Fr catheters (Medcomp, Harleysville, PA, USA) inserted into the same jugular vein were used as vascular access between January 2009 and April 2010. The catheters were inserted into the left jugular vein in 21 patients, and into the right jugular vein in 108 patients. A 30% solution of trisodium-citrate was used as a locking solution, and 2% mupirocin ointment was routinely applied to the exit site. The catheters were removed in 86 patients after 1-288 days, median 17.5 days. In 74 patients, there was either no need for further dialysis or an arteriovenous fistula was constructed (17 patients). In 10 patients, wire exchange was performed for correction of a displaced functional catheter (after 6-201 days), and in only two patients the catheters were removed due to infection on days 10 and 184. The longest period of a catheter functioning without intervention was 387 days. Fifteen patients died with functional catheters left in place (duration 1-387 days). In four patients, the catheters were still functional at the time of analysis (duration 198-268 days). Another nine patients were transferred to other dialysis centers (after they had been followed up at our center lasting for 1-63 days), with no data on their outcome after transfer. Fifteen patients were lost to follow up after insertion. Two single-lumen, noncuffed catheters in the same jugular vein, locked with 30% citrate, seem to be a safe and long lasting method of vascular access for hemodialysis and apheresis in some patients, but further prospective studies are needed to evaluate the clinical outcome of this type of vascular access.
在过去几年中，我们在血液透析（HD）和血液分离术患者中，一直将两根单腔、无套囊的导管置于同一颈静脉作为首选的血管通路。这项回顾性研究的目的是分析这种血管通路的临床结局以及导管拔除的原因。在129例年龄为69±13岁、男性占56%的成年患者中，121例接受血液透析治疗，8例接受血液分离术治疗，在2009年1月至2010年4月期间，将两根预弯的8F单腔导管（美国宾夕法尼亚州哈雷斯维尔市Medcomp公司生产）插入同一颈静脉作为血管通路。21例患者的导管插入左颈静脉，108例患者的导管插入右颈静脉。使用30%的枸橼酸钠溶液作为封管液，并在出口部位常规涂抹2%的莫匹罗星软膏。86例患者在1 - 288天（中位数17.5天）后拔除导管。74例患者中，要么不再需要进一步透析，要么构建了动静脉内瘘（17例）。10例患者进行了导丝置换以纠正移位的功能性导管（在6 - 201天后），只有2例患者因感染在第10天和第184天拔除导管。导管在无干预情况下发挥功能的最长时间为387天。15例患者在导管仍有功能时死亡（持续时间1 - 387天）。4例患者在分析时导管仍有功能（持续时间198 - 268天）。另外9例患者转至其他透析中心（在我们中心随访1 - 63天后），转院后的结局无相关数据。15例患者在导管插入后失访。两根单腔、无套囊的导管置于同一颈静脉，用30%枸橼酸钠封管，对于一些患者来说似乎是一种安全且持久的血液透析和血液分离术血管通路方法，但需要进一步的前瞻性研究来评估这种类型血管通路的临床结局。
