Permanent atrial catheters in long-term run

Since the late 70s permanent atrial catheters are in a rising extent in use for performing secure hemodialysis. In this study the long-term use of 76 subcutaneous indwelling silikone-rubber catheters was investigated. The follow-up period was 8.5 years. The first 3 catheters were implanted surgically (between 1988 and 1993), since 1993 all permanent catheters were implanted in our nephrological unit by a minimal-invasive percutaneous technique. Catheters were performed in patients either with severe shunt problems, as multiple shunt thrombosis or primary not "shuntable" vascular pattern, as diabetics, or patients who would have suffered a worsening of their cardiopulmonal situation by adding an additional shunt volume (dilatative myocardiopathy). Other reasons could have been alterations in coagulation parameters in sense of thrombophile diathesis. All in all we survey a period of 18,631 catheter days (51.04 years). The mean time of function was 245 days (2 days-1,484 days) over all catheters and terminanting endpoints. The reasons that led to explantation of catheters are specified (death, dysfunction, displacement, infection, bridging, cuff evasion). The investigation of the endpoint infection showed that it has to be distinguished between early and late infections, so that in the meantime we prefer a perioperative prophylactic application of antibiotics (ampicillin/sulbactam). There is a tendency to be seen that double-lumen catheters in comparison to single-lumen catheters show a longer mean time of function (318 vs. 221 days). The result was statistically not significant. In our opinion permanent atrial catheters have proven to be a secure, reliable, and sufficient method for performing hemodialysis in selected patients.