Tunneled dialysis catheter placement in intensive care unit patients: influence of catheter tip design on clinical performance.

Abstract

Purpose: This study evaluates catheter failure rates between a helical-tip catheter and a traditional split-tip catheter among intensive care unit (ICU) patients undergoing tunneled dialysis catheter (TDC) placement.

Materials and methods: We analyzed 1734 TDCs placed over seven years in a retrospective fashion, focusing on 340 catheters used in an ICU setting. Of these, 112 were VectorFlow catheters (32.9%), and 228 were Ash-Split catheters (67.1%). Catheter failure rates due to malfunction or infection were assessed using Kaplan-Meier analysis, while contributing factors were evaluated using Cox proportional hazards modeling.

Results: Within 90 days, 34.8% of patients experienced catheter failure. The VectorFlow catheter demonstrated superior unassisted patency at 30, 60, 90, and 180 days compared to the Ash-Split catheter (87.4 ± 3.6%, 78.0 ± 5.1%, 75.1 ± 5.0% and 60.1 ± 8.2% compared with 75.0 ± 3.3%, 62.8 ± 4.1%, 60.7 ± 4.2% and 44.3 ± 5.5% respectively, P = 0.022). Adjusted hazard ratios indicated Ash-Split catheters were nearly twice as likely to fail according to both univariate (1.72, P = 0.024) and multivariate (1.89, P = 0.017) modeling.

Conclusion: The findings suggest that the VectorFlow catheter demonstrates significantly better primary unassisted patency over the Ash-Split design in ICU settings, supporting its preferential use.