Long-Term Durability of Tunneled Hemodialysis Catheters: Outcomes from a Single Institution 22-Year Experience.

PURPOSE

To describe long-term physical durability of tunneled hemodialysis catheters, highlighted in the 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines as a specific area for future research.

MATERIALS AND METHODS

Tunneled hemodialysis catheters with known outcomes and dwell times > 1 year were entered into this retrospective study. Data includes demographics, complications, catheter type, dwell time, reason for removal, access site, and placement via exchange or de novo. Catheter durability < 1 year dwell was analyzed as a secondary aim.

RESULTS

272 catheters in 229 patients were included. Dwell times ranged from 366 to 3,802 days (median 504), totaling 162,439 catheter days. 17 (6%) catheters > 1 year dwell had broken external components. For these, dwell times until breaking ranged from 377 to 1,436 days (median 489), totaling 10,434 catheter days. 5 had a broken hub, 11 had a broken clamp, and 1 had broken hub and clamp. 12 were Ash Split Cath (n = 240) and 5 were Arrow-Clark VectorFlow (n = 32). In the durability < 1 year sub-analysis, 6,515 catheters with dwell times < 1 year in 3,693 patients were included, totaling 425,018 catheter days. 48 were damaged, with 24 broken hubs, 17 broken clamps, and 7 holes. Median time to breakage was 110 days. 38 were Ash Split Cath (n = 5,636) and 10 Arrow-Clark VectorFlow (n = 812). In both analyses, breakage was limited to hubs, clamps, and extensions.

CONCLUSIONS

Tunneled hemodialysis catheters are exceptionally durable, rarely requiring removal for hub-related issues after one year. Breakdown was not observed as a long-term durability issue. Further, broken external components can be replaced using external repair kits.

LEVEL OF EVIDENCE

Level 2b, Retrospective Study.