Right atrial silicone catheters as angioaccess for hemodialysis with special emphasis to their complications.

Right atrial silicone catheters (RASCs) serve as temporary angioaccess in hemodialysis (HD) patients. In a retrospective study of the years 1989 to 1996 we analyzed catheter-related complications, and tried to define patients at special risk for complications. We compared our results with published data on RASCs and percutaneous catheters. In 73 patients older than 64 (mean age 76) years with severe comorbidity 109 single lumen RASCs, type Demers, were implanted. Fifty-five similar catheters implanted in 44 younger patients (mean age 53) with a comparable severe comorbidity were used as controls. In the older patients the mean indwelling time was 157 (1-995) days, median 98 days, in the younger patients 135 (1-623) days, median 61 days. Early complications that led to RASC removal within one week after implantation were kinking, formation of a narrow loop, perforation, infected hematoma, and immediate clotting. Reasons for removal of the RASC after a longer period were infection, occlusion, and dislocation. In the old age group a great proportion (40%) of patients died with functioning RASC. In the literature RASCs are superior to percutaneous (Shaldon) catheters as temporary angioaccess for HD with respect to both better longevity and fewer complications such as venous stenoses or occlusions or infections. This is in accordance with our experience. However RASCs have complications, especially in the high risk groups of diabetics and patients with malignancies.