Permanent twin catheter: a vascular access option of choice for haemodialysis in elderly patients.

Abstract

The increasing incidence and prevalence of elderly endstage renal disease (ESRD) patients is an emerging Subjects and methods problem for nephrologists in charge of renal replacement therapy (RRT ). Co-morbid conditions (e.g. TCath vascular access option cardiovascular diseases, malnutrition, diabetes mellitus) frequently associated with ageing is an additional In our department, TCath was established as a vascular factor complicating the RRT strategy in elderly ESRD access tool option for ESRD patients in the early 1980s [9]. patients. Among technical difficulties encountered in From a global experience of 1580 TCaths used to treat acute treating this population, obtaining a reliable vascular and chronic renal patients, 738 TCaths satisfying the criteria access is probably one of the more frustrating [1,2]. of a permanent catheter (used for 3 months or more) inserted in ESRD patients were selected and analysed for this study Permanent vascular access [native or graft internal [10]. arterio-venous (AV ) fistula] is very often difficult to TCath is a definite option in our vascular access strategy construct (poor venous capital, mediacalcosis, artfor RRT indicated as soon as an ESRD patient requires erosclerosis, malnutrition) or useless due to low blood haemodialysis without permanent and usable vascular access. flow or poor venous network development. In patients TCath offers a very flexible solution and it may be used for with severe heart disease or atherosclerosis, an AV as long as necessary. TCaths are removed when the funcfistula is usually contraindicated to preserve a precartionality and usability of another permanent vascular access ious general or regional haemodynamic equilibrium. is confirmed. TCaths are kept and used as permanent accesses Finally, in the elderly patients with limited life expectwhen multiple attempts at creating AV fistulae have failed, ancy, very aggressive surgical attempts to create an in the very elderly patient or when a patient’s life expectancy is limited (e.g. myeloma). AV fistula do not seem ethically justified. For these reasons, a long-term catheter, a so-called permanent catheter, offers a very interesting alternative to an AV Patients fistula [3–6 ]. Permanent catheters offer several advantA total of 738 permanent TCaths were inserted during the ages: they are easy to insert under local anaesthesia; study period. Each catheter is considered as an individual they provide an immediate and long-term vascular patient despite the fact that some patients had more than access for haemodialysis; they do not compromise the one TCath at different treatment periods. Patients receiving haemodynamic equilibrium; they preserve comfort and TCath consisted of 384 males and 354 females with a mean autonomy for the patient; and they allow the delivery age of 58.4±16.3 years. All patients had chronic renal failure of an adequate dialysis dose. However, as with any requiring chronic haemodialysis. implanted foreign material, a permanent catheter increases the risk of infection and venous complications TCath insertion technique and handling (i.e. thrombosis, stenosis) [7,8]. The aim of this report is to illustrate the pivotal role TCath consists of two independent catheters made of two offered by permanent catheters (twin silicone polymer removable parts joined together at the time of insertion [11]. catheters, TwinCath, MedComp, Harleyville, USA) in The intravascular cannula is made of radiopaque silicone the vascular options for RRT in elderly ESRD patients. polymer tubing (inner/outer diameters 2.0/3.2 mm), the length differing according to the side of insertion: 28–30 cm The study reviews our experience during the period and 32–34 cm for the right and left sides respectively. Six 1982–1997 using the TwinCath (TCath) as a permanholes are disposed spirally along their distal tip. The extension or connecting cannula is made of 6–7 cm silicone polymer of larger diameter ending in a nylon luer lock connection Correspondence and offprint requests to: B. Canaud, Nephrology, Lapeyronie University Hospital, 34295 Montpellier, France. device.