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What is the Role of Permanent Central Vein Access in Hemodialysis Patients?

Reliable maintenance hemodialysis vascular access remains one of the major problems in delivering adequate outpatient hemodialysis. In addition, 25% of all admissions and hospital days are attributed to vascular access related causes. Adequate vascular access should provide sufficient extracorporeal blood flow without recirculation to deliver adequate hemodialysis and should be relatively trouble-free; in the U S . , this requires blood flows of at least 400 mllmin. Dual-lumen central vein hemodialysis catheters have been widely used for acute hemodialysis access since the early 1980s but high infection rates and low blood flow capabilities limited their use to temporary access. Since 1985, dual-lumen silicone and silastic hemodialysis catheters with anchoring tunneled cuffs [e.g., PermCath (Quinton Instrument Company, Seattle)] have been developed and have a longer use-life and lower complication rate than do acute hemodialysis catheters raising the possibility of permanent central vein access. Initially, these catheters were advocated as prolonged temporary catheters to serve as a bridge until permanent vascular access matured. Clinical practice, however, has evolved to the point that this class of catheters is being used widely for permanent vascular access. Are they adequate permanent access?