Zhang Austin, Clark Timothy Wi, Trerotola Scott O
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Cardiovasc Intervent Radiol. 2025 May;48(5):619-625. doi: 10.1007/s00270-024-03941-4. Epub 2025 Feb 4.
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.
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.
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.
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 2b, Retrospective Study.
描述隧道式血液透析导管的长期物理耐用性，这在2019年《肾脏病预后质量倡议》（KDOQI）指南中被列为未来研究的一个特定领域。
将已知结局且留置时间>1年的隧道式血液透析导管纳入这项回顾性研究。数据包括人口统计学资料、并发症、导管类型、留置时间、拔除原因、穿刺部位以及通过置换或初次置入的放置方式。将留置时间<1年的导管耐用性作为次要目标进行分析。
纳入了229例患者的272根导管。留置时间为366至3802天（中位数为504天），总计162439导管日。17根（6%）留置时间>1年的导管外部部件出现破损。对于这些导管，直至破损的留置时间为377至1436天（中位数为489天），总计10434导管日。5根导管的接头破损，11根导管的夹片破损，1根导管的接头和夹片均破损。12根为灰阶分体导管（n = 240），5根为箭式 - 克拉克矢量流导管（n = 32）。在留置时间<1年的亚组分析中，纳入了3693例患者的6515根留置时间<1年的导管，总计425018导管日。48根导管出现损坏，其中24根接头破损，17根夹片破损，7根有孔洞。破损的中位时间为110天。38根为灰阶分体导管（n = 5636），10根为箭式 - 克拉克矢量流导管（n = 812）。在两项分析中，破损均局限于接头、夹片和延长管。
隧道式血液透析导管具有极高的耐用性，一年后很少因与接头相关的问题而需要拔除。未观察到故障是长期耐用性问题。此外，破损的外部部件可使用外部修复套件进行更换。
2b级，回顾性研究。
