[Central vascular access: rational and results]

Central venous catheterization for hemodialysis using double cannula has become the preferred central vascular form in acute cases. Moreover, in chronic cases, this form of vascular access has replaced the internal arterio-venous fistula whenever the latter is difficult to realize, or when patient's cardio-circulatory condition would discourage its creation. The central vascular access presents frequent complications, compromising their efficiency and duration. Tesio's central venous catheters were thoroughly studied and manufactured to overcome these complications, allowing a long life span of the vascular access. In this study 108 patients with Tesio's internal jugular central venous catheters were followed-up in the period 1990 to 1994. All patients underwent hemodialysis in Pordenone Center. Central venous access survival fluctuated between 93% and 82% in the first year and the fifth year respectively. However, access survival dropped to 32% after seven years. The accurate choice of the catheters' manufacturing material as well as the correct technical positioning has determined a significant increase in the vascular access survival, thanks to the important decrease in prevalence and seriousness of complications. We believe that the decreased accuracy in catheter management over time is the major cause of delayed loss of the central vascular access.

Roman Tunnelling Tool

The aim of this paper is to present an instrument that helps to create a subcutaneous path for central catheters used for hemodialysis, as well as a non traumatic internal introduction of Tesio's catheters and other systems (Dacron cap). We have designed a tunneling tool which consists of a solid but light weight hand set, connected to an extension that ends with an olive shape dilator to be connected to a trocar. Thus, precise tunneling is guaranteed through a non traumatic procedure, allowing exact anchorage of catheters.