[Complications related to permanent deep venous catheterization using dual lumen hemodialysis catheter].

OBJECTIVE: To observe the incidence of long-term venous indwelling catheter related complications in hemodialysis patients and to report our clinical approach to the complications. METHODS: A hundred eleven hemodialysis patients was prospectively studied from Jan. 2001 to Mar. 2003, in whom the venous indwelling catheter had been in place for more than 6 months. Catheter related complications were observed over a total period of 1090 patients months, with a mean period of 9.8 months (6 - 27 months). RESULTS: The incidence of hematoma was 8.1% (9/111), and that of catheter malposition was 4.5%. There was no hemothorax, pneumothorax, air embolism or veinous laceration. Six episodes of catheter related infection were observed during the observation, with an incidence of 5.4%; two cases with bacterial infection were successfully treated; while among the 4 cases with fungal infection, one was successfully treated and catheters were removed in other 3 cases for uncontrolled infection. The incidence of catheter thrombosis was 18.9% (21/111) and the catheter had been used for a mean period of 36 days (6 - 725 days) from placement to thrombosis. Catheter patency was restored in 95.2% (20/21) by urokinase infusion. Recurrent thrombosis occurred in 18 of 20 catheters (90.0%), of which 5 worked functionally following anti-platelet therapy and 13 had recurrent thrombosis. Following anticoagulation by warfarin, 9 became functional (69.2%), but the other 4 cases turned to other vascular access. Urokinase infusion followed by anticoagulation had prolonged the mean catheter life-time for 6 months (3 - 18 months). CONCLUSION: Cuffed dual lumen catheter as permanent access is safe and effective. Catheter thrombosis is the most common complication. Urokinase infusion followed by anticoagulation can significantly prolong the catheter life-time.