ABSTRACT

Use of the Femoral Vein as Insertion Site for Tunneled Hemodialysis Catheters

The femoral vein provides an alternative access site for insertion of tunneled hemodialysis catheters when conventional sites are not available. Tunneled femoral hemodialysis catheters have low primary patency rates and significant complications. Catheter retraction is a unique and common problem. However, the use of the femoral vein remains acceptable in those patients who have limited options for long-term hemodialysis.

ABSTRACT

Purpose Currently available 4 French and 5 French PICCs were investigated to evaluate their possible application for contrast injection using power injectors. The study was performed using an in-vitro model to demonstrate the feasibility of using PICCs for contrast enhanced studies.

Materials and Methods An evaluation of 24 catheter versions consisting of 4 French single lumen and 5 French dual lumen PICCs from 13 different manufacturers was conducted. Six of the catheter types were silicone and 18 catheter types were polyurethane. Ten catheters of each type were evaluated with five at full length and five trimmed to 40cm. Using a silicone-based simulated superior vena cava model, the catheters were infused with 50cc of intravenous contrast at each flow rate increment. Catheters were tested at increasing flow rates from 0.5cc/second to 5cc/second in 0.5cc/second increments using a Percupump CT injector. Catheters that failed to rupture were then infused at 1 cc/second increments at flow rates from 5cc/second to 17cc/second using a MedRad Mark V^TM power injector. Tolerated and bursting pressures were recorded.

Results Polyurethane catheters ruptured at flow rates between 4–15.4cc/second, with one catheter not rupturing at the maximum flow rate (l7cc/second). Silicone catheters ruptured at flow rates between 0.5–3.5cc/second. Average rupture locations by type and length were at the extension leg/hub connection area on 5 of the PICCs, on the extension legs on 21 of the PICCs, on the catheter/hub connection on 4 PICCs, and on the proximal catheter on 16 of the PICCs.

Conclusion The low burst rates at which all silicone catheters ruptured suggest those catheters are not able to withstand typical flow rates used for CTA. Conversely, although a wide range of discrepancy is found in the polyurethane catheter burst pressures, many polyurethane catheters can tolerate relatively high flow rates without rupture. This suggests that they may be safely used for CTA with appropriate precautions and protocols in place.

Abstract

While immunoglobulin therapy has been available in healthcare for many years, the issues related to new brands, product availability, costs and safety continue to change. The shortages of the last ten years and concerns over the transmission of Hepatitis and/or HIV have been replaced with other equally complex and challenging concerns to both patients and clinicians. This article examines the most urgent of those concerns and describes the relevance these issues have to clinical practice.