Tunneled hemodialysis catheter survival: comparison of radiologic and surgical implantation.

Abstract

Cuffed, tunneled hemodialysis catheters (caths) are often implanted in the operating rooms (OR) by surgeons or by interventional radiologists in radiology suites (RS). Comparative outcome studies between OR and RS placed caths are few and tend to favor the specialty of the authors. In this longitudinal study, we monitored cath survival in patients while awaiting maturation of their fistulae, and compared outcomes between OR and RS placement. A total of 95 caths were placed in 50 patients between July 1996 and July 1999. Radiologically placed caths had a shorter primary patency duration than OR placed caths (80 +/- 40 days vs. 100 +/- 31 days, p = 0.04) and a lower primary patency rate at 120 days than OR placed caths (42% vs. 67%, p = 0.04). Cumulative infection rate per 1,000 catheter days was higher in RS than OR cases (3.8 Vs 2.2, p = 0.09), whereas mean sepsis free duration was shorter in RS than OR (60 +/- 45 days vs. 88 +/- 40 days, p = 0.02). The risk of infection was 1.7 times greater in RS than OR cases (chi-square = 6.4, p = 0.01). The RS placed caths also had a higher rate of primary nonfunction (31% vs. 8.3%, p = 0.04) and bleeding complications (42% vs. 17%, p = 0.04), but significantly shorter procedure scheduling time than OR cases (1.1 +/- 0.3 days vs. 2.5 +/- 0.6 days, p < 0.0001). In conclusion, radiologically placed caths seem to have higher rates of infection, bleeding, and functional failure but shorter scheduling time than surgically placed caths. Discussions are under way to improve the survival of RS placed caths at our affiliated hospitals.