Tunneled femoral dialysis catheters and factors affecting their outcome: a single institution experience

Abstract

Background: To assess a single-center experience with tunneled femoral dialysis catheter usage and outcomes and to identify any operator-dependent factors related to risk of premature catheter failure.

Methods: Retrospective review of the institutional radiology information system for tunneled femoral dialysis catheter placement from 2010 to 2017 was performed. Patients for whom the catheter was placed for an indication other than dialysis or who were less than 18 years of age at the time of catheter placement were excluded. Premature catheter failure rate, cause of premature failure, catheter patency (in days) and infection rate were assessed. Operator/placement characteristics, including laterality, catheter tip placement, and catheter length were also assessed.

Results: A total of 101 patients were included in the study. This included n = 116 catheter placements. Thirty-four percent of patients (n = 40) were lost to follow-up, resulting in n = 61 patients and n = 76 catheters analyzed. Premature catheter failure rate was 48% (n = 36), with low flows being the foremost cause of failure (64%, n = 23). Average primary patency of these catheters was 82.4 days (1-328 days). About 8% of catheters (n = 3) were complicated by infection, resulting in an infection rate of 0.4/1000 catheter days. None of the operator-dependent factors analyzed, including catheter laterality, catheter tip placement, and catheter length, demonstrated a significant association with premature catheter failure.

Conclusions: Institutional primary access patency rates are comparable to or higher than previously published data, while infection rates are similar to or lower than those reported in the literature. None of the operator-dependent factors related to placement was shown to significantly decrease the risk of premature catheter failure. These findings suggest that while femoral dialysis catheters do not function well in the long term relative to internal jugular vein dialysis catheters, prior literature may undervalue their utility and function, particularly given that these catheters are used as a "last resort" for many patients.

Keywords: Dialysis access; catheters; dialysis; end stage renal disease; tunneled femoral catheter.