Use of Permcath (Quinton) Catheter in Uraemic Patients in Whom the Creation of Conventional Vascular Access for Haemodialysis Is Difficult

Abstract

During the last 4 years, the Permcath Quinton double-lumen silicone catheter was inserted into the internal jugular vein of 57 uraemic patients with difficulty for creating conventional vascular access for haemodialysis. In 4 patients, with definitive contraindication of conventional vascular access, this catheter still permits haemodialysis after a duration of 8–25 months. In 25 further patients with terminal uraemia, but poor vein system, it allowed the maturation of an arteriovenous fistula after 2–14 months of use. In 17 patients already on chronic haemodialysis, but who lost abruptly their vascular access (15 grafts and 2 arteriovenous fistulae), it allowed a new arteriovenous fistula to mature in 16 cases after a mean duration of 7.3 ± months. In 5 patients with short life expectancy because of neoplasia, it allowed to dialyse them until their death which occured after 6.5 ± 2.2 months. In 6 patients with acute renal failure and haemostasis problems, it allowed to perform not only dialysis, but also plasmapheresis in 3 and parenteral nutrition in 3 other cases. The complications were the following: sepsis (n = 3); episodes of hypocoagulability due to inadvertent injection of heparin stored in the lumen (n = 2), thrombosis of the lumen (n = 3), and insufficient flow (n = 6). In no case these complications prevented continuation of haemodialysis. The catheter had to be removed in 2 cases because of septis and in 1 case because of insufficient flow. In 3 cases the catheter had to be replaced because of thrombosis and in 1 case because of laceration. These complication rates are, however, fewer than those reported in the literature for arteriovenous shunts or rigid subclavian and femoral catheters. The Permcath catheter seems, therefore to be the method of choice for immediated vascular access in patients in whom the creation of conventional vascular access is difficult.

Circulating Bacterial-Derived DNA Fragments and Markers of Inflammation in Chronic Hemodialysis Patients

“…Interestingly, such lack of difference was evident in both patients with and without evident causes of inflammation. Serwanska-Swietek et al (30) were able to detect the presence of a DNA fragment of approximately 790 bp in length in all of the whole blood samples randomly selected from a group of 50 hemodialysis patients without signs of active infection but did not correlate this presence with markers of inflammation. With regard to other diseases, Sleigh et al have shown that 16S rDNA PCR resulted positive in 14.8% of critically ill patients with negative blood cultures and was approximately twice as sensitive as blood culture in detecting bacteraemia in patients who previously received antibiotics (17).…”

“…Confirmation of the present study results by future studies may raise the question of how to manage bacterial DNA detected in the whole blood of hemodialysis patients. To the best of our knowledge, there are limited data on this issue (9,30). In general, the presence of bacterial DNA in the whole blood is considered an expression of bacteraemia and suggests that the patient be considered for antibiotic therapy (16 -19,31).…”

Current Management of Vascular Access

“…One option is to continue systemic antibiotics alone, in an attempt to salvage the infected catheter. This approach should be discouraged, because bacteremia recurs in approximately 75% of patients once the course of antibiotics has been completed (98,135,138,146,147). In a recent prospective study, the risk for treatment failure was five-fold higher in patients with attempted catheter salvage, as compared with patients in whom the infected catheter was removed (140).…”

Long-Term Outcome of Permanent Hemodialysis Catheters: A Controlled Study

“…Several different catheters are available world-wide. The two most popular types used in France in the 1990s were the Permcath cuffed double catheter [2,3,5,[19][20][21], and the TwinCath noncuffed catheter described first by Canaud et al [4], then modified by Tesio et al [6] as a cuffed version. These two devices represent two different approaches to avoid dysfunction and infectious catheterrelated problems.…”