Schwab S J, Buller G L, McCann R L, Bollinger R R, Stickel D L
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
Am J Kidney Dis. 1988 Feb;11(2):166-9. doi: 10.1016/s0272-6386(88)80206-3.
Double lumen subclavian venous hemodialysis catheters are in wide use in the United States to provide temporary vascular access. The disadvantages of these catheters include a high infection rate and short use-life (2 to 3 weeks). We evaluated a felt cuffed tunnelled jugular venous hemodialysis catheter (PermCath) to determine its ability to overcome these shortcomings and compared it with standard noncuffed double lumen dialysis catheters. Eighty PermCaths were inserted during this prospective study in patients needing temporary vascular access in excess of 1 month. Median use-life of these catheters was 8 weeks with a use range of 3 weeks to 5.4 months. Only four functioning catheters failed before elective removal. Despite the prolonged use-life there was only one episode of catheter mediated bacteremia. Seven catheters (9%) failed to function immediately after insertion. These failures were caused by catheter kinking in the region of the felt cuff. Thrombosis of the catheter lumen was the most frequent complication (137 episodes) but resolved in over 95% of the instances with urokinase instillation. Exit site infections (23 instances) were successfully treated conservatively. We conclude that the PermCath (Quinton Instrument Co, Seattle) is a safe and reliable new device with a low complication rate and a longer use-life than standard subclavian dialysis catheters. This longer use-life allows more time for maturation of primary arteriovenous (AV) fistulas and Tenckhoff peritoneal dialysis catheters, and provides time for the healing of infected vascular access grafts. Its primary disadvantage is the need for surgical insertion.
双腔锁骨下静脉血液透析导管在美国被广泛用于提供临时血管通路。这些导管的缺点包括感染率高和使用寿命短（2至3周）。我们评估了一种带毡套隧道式颈静脉血液透析导管（PermCath），以确定其克服这些缺点的能力，并将其与标准的无套双腔透析导管进行比较。在这项前瞻性研究中，为超过1个月需要临时血管通路的患者插入了80根PermCath导管。这些导管的中位使用寿命为8周，使用范围为3周至5.4个月。只有4根功能正常的导管在择期拔除前出现故障。尽管使用寿命延长，但仅发生了1次导管介导的菌血症。7根导管（9%）在插入后立即无法正常工作。这些故障是由毡套区域的导管扭结引起的。导管腔血栓形成是最常见的并发症（137例），但超过95%的病例通过尿激酶灌注得以解决。出口部位感染（23例）通过保守治疗成功治愈。我们得出结论，PermCath（昆顿仪器公司，西雅图）是一种安全可靠的新装置，并发症发生率低，使用寿命比标准锁骨下透析导管更长。这种更长的使用寿命为原发性动静脉（AV）内瘘和Tenckhoff腹膜透析导管的成熟留出了更多时间，并为感染的血管通路移植物的愈合提供了时间。其主要缺点是需要手术插入。
