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document
Hemodialysis catheter design and catheter performance : a randomized controlled trial . BACKGROUND A complication of long-term use of tunneled cuffed catheters for hemodialysis is the high rate of infection and thrombus-related dysfunction . Specific mechanical features of tunneled cuffed catheters may improve hemodynamic performance and decrease thrombosis and infection rates . However , there currently is no proven advantage of one design over another . STUDY DESIGN Single-center randomized clinical trial . SETTING & PARTICIPANTS 302 hemodialysis patients who required a tunneled cuffed catheter as temporary or definite vascular access . INTERVENTION Palindrome Symmetric Tip Dialysis Catheter or HemoStar Long-Term Hemodialysis Catheter . OUTCOMES & MEASUREMENTS The primary end point was primary assisted patency . Secondary end points were incidence of catheter-related bloodstream infections ( CRBSIs ) , thrombosis , and 2 indicators of rheologic function : mean effective blood flow rate and urokinase use . RESULTS Mean primary assisted patency was 135.9 days for Palindrome and 136.5 days for HemoStar ( P=0.8 ) . Definite CRBSI occurred in 0.24 and 0.10/1,000 catheter-days for Palindrome and HemoStar , respectively ( P=0.3 ) . Removal rates for thrombosis that could not be resolved with thrombolysis were 0.53 and 0.43/1,000 catheter-days for Palindrome and HemoStar , respectively ( P=0.7 ) . Urokinase use was lower for Palindrome than for HemoStar , as evidenced by a lower number of urokinase infusions/1,000 catheter-days ( 17 and 35 ; P < 0.001 ) and higher number of catheters that never required thrombolysis ( 58 % and 45 % ; P=0.03 ) . Mean effective blood flow rate was higher for Palindrome than for HemoStar ( 333 and 304mL/min ; P < 0.001 ) . LIMITATIONS Single-center nonblinded trial . CONCLUSIONS Primary assisted patency and incidence of infection and thrombosis were similar for both catheter types . The Palindrome catheter required less thrombolysis and achieved higher blood flow rates than the HemoStar catheter . These findings suggest that mechanical catheter design may improve catheter rheology , but does not affect risks for thrombosis and infection and hence catheter survival .
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Intervention_Physical
tunneled cuffed catheters
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Intervention_Physical
tunneled cuffed catheters
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Intervention_Physical
tunneled cuffed catheter
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Intervention_Physical
Palindrome Symmetric Tip Dialysis Catheter or HemoStar Long-Term Hemodialysis Catheter .
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Intervention_Physical
Palindrome
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Intervention_Physical
HemoStar
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Outcome_Physical
infection
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Outcome_Physical
thrombus-related dysfunction .
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Outcome_Physical
primary assisted patency .
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Outcome_Adverse-effects
incidence of catheter-related bloodstream infections ( CRBSIs )
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Outcome_Physical
, thrombosis , and 2 indicators of rheologic function : mean effective blood flow rate and urokinase use .
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Outcome_Physical
Mean primary assisted patency
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Outcome_Physical
CRBSI
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Outcome_Physical
Removal rates for thrombosis
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Outcome_Physical
Urokinase use
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Outcome_Physical
urokinase
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Outcome_Adverse-effects
catheters that never required thrombolysis
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Outcome_Physical
Mean effective blood flow rate
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Outcome_Physical
Primary assisted patency and incidence of infection and thrombosis
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Outcome_Physical
thrombolysis
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Outcome_Physical
blood flow rates
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Outcome_Physical
thrombosis
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Outcome_Adverse-effects
infection
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Participant_Condition
Hemodialysis catheter design and catheter performance
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Participant_Sample-size
302