The Duo Split Acute Hemodialysis Catheter: a Two-Limbed Acute Hemodialysis Catheter with Novel Technique for Insertion

Acute hemodialysis catheters are designed to be placed over a guidewire into the central veins by Seldinger technique, and therefore are rigid with a pointed tip. The guidewire technique avoids the need for tunneling the catheter and threading the catheter tip through a thin-walled 'sheath' with risk of blood loss or air embolus. Acute catheters generally provide lower and more irregular blood flow than chronic tunneled catheters such as the Ash Split Cath, and average duration of use is limited to a only a few days due to risks of infection or vein irritation. The Duo Split is a flexible acute catheter with two separate intravascular limbs, each with a blunt cylindrical tip and multiple side-holes similar to the Split Cath, but without a cuff and subcutaneous tunnel. A single-slotted 'Quill' guide surrounds the catheter during placement, with a tapered tip that follows the guidewire into the vein. Simple traction on the Quill causes the tapered tip and the slot to expand around the catheter, leaving the Duo Split in place within the vein. DuoSplit catheters were placed into the femoral vein (4) and IJ vein (2) of 6 patients with acute renal failure. During dialysis blood flow rates (BFRs) of 200-300 ml/min were obtained (average 229 ml/min) with average venous pressures of 150 mm and average arterial pressures of 192mm. Flow rates and pressures were similar to conventional acute catheters placed mostly in the IJ vein. Duration of Duo Split catheter use was longer at 6.2 days (maximum 11 days) versus 4.0 days for conventional catheters. There were no complications of clotting, septicemia, exit infection or loss of blood flow. The DuoSplit catheter in the femoral or IJ vein provides adequate blood flow rate for treatment of acute renal failure, and may allow longer catheter use than with conventional acute catheters.