Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

Abstract

To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Mean catheter primary patency failure time was 96.3days (SE 17.9days). Primary patency at 30, 60, 90, and 180days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p=0.009), were of increasing age at the time of insertion (p=0.002) and that those who had diabetes (p=0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.