Abstract
The likelihood of placing Dual-lumen catheters (DLC) is increasing with the rise in the number of diseases for which plasma apheresis is efficacious and with the development of immunoadsorption and lipid adsorption. The most common problem resulting from long-term use of DLC is poor blood flow. We have previously reported that the tip shape of DLC and poor blood flow are closely related. Since the development of NiagaraTM, which has a unique tip shape similar to the ideal shape, we evaluated its properties in comparison with those of three other DLCs. In a clot-removing test, NiagaraTM removed clots formed in arterial and venous lumens nearly perfectly by aspiration. There was no difference in the blood recirculation rate (in vitro: <4%) among these DLCs. Although NiagaraTM has a large diameter and exhibited high resistance during an insertion test, it could be relatively easily inserted with a stylet, unlike the standard end-hole type catheter. Of 15 cases using NiagaraTM, only one exhibited poor blood flow due to clots. In the other 14 cases, there was sufficient blood flow without periodic or continuous injection of heparin or solutions into the catheter, and hemodialysis could be performed continuously for 37 days (longest). We consider NiagaraTM the best DLC currently available despite a few shortcomings.
