Article Text

  1. B. Sachdeva1,
  2. N. K. Atray1,2,
  3. T. J. Vachharajani1,2
  1. 1Louisiana State University Health Sciences Center, Shreveport, LA
  2. 2Overton Brooks VA Medical Center


Background Unfortunately, cuffed tunneled catheters (CTC) have become an integral part of hemodialysis and many designs have been developed to achieve optimal performance and longevity. The ideal catheter design would have low recirculation values, high blood flow rates and better biocompatibility. Recirculation rate (RR) may vary with catheter design and worsen with reversal of ports. Even though reversal of ports is not recommended, it is frequently relied upon to provide dialysis support. The aim of this study was to measure blood flow recirculation with standard and reverse connection using two different catheter designs (AshSplit II and Arrow Cannon).

Methods We retrospectively reviewed the performance of 12 catheters that were placed in the interventional suite. All CTC were placed in right internal jugular (IJ) vein by the same nephrologists under fluoroscopy. The RR was calculated using Crit-LineIII optical monitor on first CTC use after insertion, by the same operator, at blood flow rates (Qb) of 300 mL/min and 400 mL/min in standard (≠) and reverse connection (↓).

Results RR are listed in the table below (expressed as mean % ± SD. The venous pressure (VP) simultaneously measured were AshSplit II 150 ± 50 mm Hg (Qb300 mL/min) and 190 ± 50 mm Hg (Qb400 mL/min); VP with Arrow Cannon 164 ± 60 mm Hg (Qb300 mL/min) and 225 ± 175 mm Hg (Qb400 mL/min). VP was not different during reverse connection.

Conclusion Recirculation rates were identical with both catheter designs using standard connection. However, AshSplit II catheter design favors low recirculation compared to Arrow Cannon when connections are reversed.

Discussion Difference in the CTC tip design possibly plays a role in the observation noted in our study. Spatial distance between arterial and venous end with V-tip design of Arrow Cannon probably creates more turbulence compared to the Tip hole design of AshSplit II, resulting in higher recirculation rates with reverse connection.

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