Preliminary experience with a new design for a tunneled, cuffed catheter for hemodialysis

Abstract

Purpose: The use of tunneled, cuffed central venous catheters for hemodialysis is associated with poor flow, thrombosis, and infections due to the transcutaneous nature of these devices. A new design for a sutureless, tunneled cuffed catheter was evaluated in hemodialysis patients to determine the effect of its design on the incidence of exit site infection. Methods: A polyurethane conduit with a uniquely designed cuff and subcutaneous skirt covered with Dacron velour was attached to standard double lumen central venous catheters. Seven (7) Ash catheters and one (1) Tesio catheter were fitted with the overtube and skirt and implanted in eight (8) patients undergoing routine hemodialysis. Patients were monitored for exit site infection, tunnel infection, bacteremia, cuff extrusion, and serosanguineous exudate. Results: Catheters were implanted for 6 to 26 weeks. All catheters remained patent and no cases of bacteremia were observed. There was no evidence of exit site or tunnel infection, and no reported serosanguineous exudate from the exit site. Exit site care consisted of soap and water cleansing by the patient. Patients were able to shower or bathe 4 weeks post‐implant. Conclusions: The new design for a subcutaneous cuff and skirt appears to inhibit exit site infection and other common complications of central venous catheters.