Large-Bore Catheters as Vascular Access for Extracorporeal Detoxification Methods: Advantages, Disadvantages, and Necessary Improvements

After the introduction of large-bore catheters with the Seldinger technique into the vena cava superior via the internal jugular veins in 1979, the advantages of this puncturing technique versus the puncture of the femoral or subclavian veins were seen. However, complications and side effects of the puncture of the internal jugular vein, such as faulty punctures, bleeding, hematothorax, thrombosis and faults in catheter material and infections were observed, too. Infections, thrombosis, and stenosis are among the most frequent side effects associated with blood-contacting catheters. These side effects are usually related to surface properties and the material of these catheters. Surface treatment processes, such as ion implantation and ion beam assisted deposition, and microdomain structured surfaces, could be used to mitigate such complications. The complication rate was first retrospective about 28 %. A second retrospective study of surface treated catheters with silver versus untreated catheters showed 75 % decline in the infection and thrombosis rate in the surface treated catheters. However, this cannot be confirmed with more available data of these patients. One reason may be that in the surfaces treated catheters only the outer surface was coated with silver and the possibilities of contamination by handling during treatments. New materials and technologies which include the outer and inner surface are necessary to reduce the tremendous discomfort of patients and the high costs of the catheter-related infections.