Clot accumulation at the tip of hemodialysis catheters in a large animal model

BACKGROUND: The issue of side holes in the tips of the tunneled cuffed central venous catheters is complex and has been subject to longstanding debate. This study sought to compare the clotting potential of the side-hole-free Pristine hemodialysis catheter with that of a symmetric catheter with side holes. METHODS: Both jugular veins of five goats were catheterized with the two different catheters. The catheters were left in place for 4 weeks and were flushed and locked with heparin thrice weekly. The aspirated intraluminal clot length was assessed visually prior to each flushing. In addition, the size and weight of the clot were recorded upon catheter extraction at the end of the 4-week follow-up RESULTS: The mean intraluminal clot length observed during the entire study follow-up measured up to a mean of 0.66 cm in the GlidePath (95% CI, 0.14–1.18) and 0.19 cm in the Pristine hemodialysis catheter (95% CI, −0.33 to 0.71), the difference being statistically significant (p = 0.026). On average, 0.01 g and 0.07 g of intraluminal clot were retrieved from the Pristine and GlidePath catheters, respectively (p = 0.052). CONCLUSION: The Pristine hemodialysis catheter was largely superior to a standard side hole catheter in impeding clot formation, and, contrary to the side hole catheter, allowed for complete aspiration of the intraluminal clot.