Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

Abstract

Background. Recently, interventional radiologists have adopted an increasingly prominent role in the placement and management of hemodialysis catheters, as well as in the research and development of new and better catheters. The purpose of this study was to evaluate the viability and hemodialysis efficiency of the AshSplit catheter and the Permcath catheter. Methods. 204 consecutive patients requiring radiological insertion of hemodialysis catheters were followed, retrospectively, over a 42-month period. Both hemodialysis catheters were placed using a combination of ultrasonic and fluoroscopic guidance and tunneled appropriately. Information collected included catheter insertion sites, insertion complications, catheter duration, and final outcome. Results. Over the study period of two years, 269 catheters were placed into 204 patients with end stage renal failure. Patients received either an AshSplit (101 patients, 127 catheters) or a Permcath (103 patients, 142 catheters). Vascular access route of choice was the right internal jugular vein (67% AshSplit, 71% Permcath). Insertion complications occurred in 18 patients overall (6.6%), with only 1 requiring further intervention (hemopneumothorax). Flow rates averaged 259 mls/min for AshSplits and 248 mls/min for Permcaths (p < 0.001). Follow-up of catheter viability for 42 months yielded a mean AshSplit catheter duration of 246 days (range 6-932) and 239 days (range 1-1,278) for Permcath (p = 0.46). Reasons for catheter failure and elective catheter removal were similar in both groups; however, Permcaths required significantly more thrombolysis than AshSplits, p < 0.001. Conclusion. The AshSplit provides significantly better flow rates and less thrombolysis compared to the Permcath, with similar catheter dwell times.

A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters

“…In contrast, Trerotola et al 18 reported a significant survival benefit instead for split-tip compared with step-tip catheters (P ¼ .022). However, Keeling et al 13 reported no statistical difference (P ¼ .498) in catheter survival curves for step-and split-tip catheters.…”

“…Thus, eight studies were eligible for inclusion in this meta-analysis. 6,[12][13][14][15][16][17][18] These eight studies were published between 1999 and 2014. Four studies recruited patients using step-tip or split-tip tunneled HD catheters.…”

“…Four studies recruited patients using step-tip or split-tip tunneled HD catheters. 13,15,17,18 Another two trials recruited patients using three types of HD catheters, namely, step-tip, split-tip, and dual-lumen catheters. 14,16 Two trials recruited patients who received HD through step-tip and symmetrical-tip catheters.…”

“…6,12 OptiFlow (Bard Access Systems, Salt Lake City, Utah) step-tip catheters were used in two trials, 16,18 PermCath in two studies, 13,15 Mahurkar (Medtronic, Santa Rosa, Calif) in one trial, 14 and HemoStar (Bard) and Hickman (Bard) in two trials, respectively. 6,17 Four studies compared the outcomes of step-tip and split-tip catheter use 13,15,17,18 ; two compared the outcomes of the step-tip, split-tip, and twin catheter use 14,16 ; and the other two compared the outcomes of the symmetrical Palindrome catheters and step-tip catheter use. 6,12 In addition, in most of the included studies, the catheter insertion site was the right internal jugular to minimize variables during comparison.…”

“…Five studies compared catheter survival in patients using different types of catheters by plotting survival curves during the study period. 6,12,13,15,18 Catheter survival time is generally defined as the time from the insertion of the catheter to the exchange or removal of the catheter due to dysfunction. The major indications for catheter removal for all studies were thrombosis and infection.…”