Successful use of double-lumen, silicone rubber catheters for permanent hemodialysis access

Abstract

Repeated, long-term access to the vascular system is a prerequisite for successful extended care of patients with endstage renal disease (ESRD) treated with hemodialysis. Other modern treatment modalities such as plasmapheresis and photopheresis also require vascular access. Native vessel arteriovenous fistulae or polytetrafluoroethylene (PTFE) interposition grafts are the most commonly used forms of permanent vascular access, but both have their limitations [11. In many older patients or patients with several prior vascular accesses, peripheral vessels may be insufficient for the creation of a new access. Interposition grafts are plagued by venous stenosis, thrombosis, and infection. In patients with advanced cardiovascular disease, the shunt effect of these grafts may worsen pre-existing angina or congestive heart failure [2]. Recently, a double-lumen, central venous catheter made of silicone rubber has been developed for use as a vascular access device. This device is particularly useful in patients who have exhausted other vascular access sites or who have severe cardiovascular disease. In this report, we present our extended experience with this new access device in hemodialysis patients.