Vascular Access for Hemodialysis: An Historical Perspective of Intravenous Catheters

introduced by Shaldon et al in 1961 (1). Shaldon used polytetrafluoroethylene (Teflon) tubings for femoral artery and vein catheterization for repeated hemodialysis. Shaldon gradually improved his method and in 1964 used Teflon tubing with silicone rubber extensions for venovenous catheterization of femoral veins (2). Percutaneous subclavian vein catheterization was introduced by Aubaniac in 1952 (3) and gained popularity after it was shown to be the most convenient site of catheter insertion for central venous pressure monitoring (4). In 1967 Christensen et al (5) reported their experience with 129 subclavian vein catheterizations and reviewed the results of more than 1,350 subclavian vein cannulations reported in the literature. The majority of the catheters remained in place for less than five days. Pneumothorax (29 cases) and arterial puncture (13 cases) were the most common complications followed by wrong position (12 cases), hemothorax (5 cases), subcutaneous hematoma (5 cases), infection with sepsis (4 cases), nonfatal air insufflation (4 cases), and nerve lesion (1 case). The authors recommended the method as valuable because it was associated with low complication rates. On the contrary, Shapira and Stern (6) based on their experience and that of others, recommended this technique be abandoned. Instead, they favored cannulation through the external jugular vein, the method described a year earlier by Rams, Daicoff and Moulder (7). No complications were reported in 275 cannulations using this method. Subclavian vein cannulation for hemodialysis was first described by Erben et al in 1969 (8). These authors used two single-lumen catheters inserted into both subclavian veins (59 cases), the same subclavian vein (14 cases), or one inserted in a subclavian vein and the other in a femoral vein (28 cases). All subclavian catheters were inserted through the infraclavicular route using the Seldinger method of insertion (9). The catheters were left in place for up to one month. De Cubber et al (10) and Uldall et al (11) used single-lumen subclavian cannulae for repeated dialysis leaving them in place for prolonged periods. Both groups employed the Seldinger method of insertion and used single-needle dialysis. Although jugular vein cannulation has been practiced by generations of pediatricians, catheterization of these veins for central pressure monitoring and fluid delivery was introduced in adults in the 1960s. Internal jugular vein catheterization through the anterior approach was described by Hermosura et al in 1966 (12). In the same year, external jugular vein cannulation was introduced by Rams et al (7). In the early 1980s, two lumen catheters were introduced because the time of vessel cannulation could be reduced by half. Initially, stiff tetrafluoroethylene (13) or polyurethane (14) catheters were used. The first, double-lumen catheter, was developed by Vas-Cath of Canada and consisted of 17 cm long “arterial cannula” with six spirally placed side holes near the tip, and a 19 cm long inner, coaxially placed “venous cannula”. The venous cannula was replaced for each dialysis. The second catheter was developed by Quinton Instruments in Seattle, WA, consisting of a septate dual-lumen design. Both companies improved designs, and their catheters are widely used for short-term therapy. A proper terminology for a catheter with two lumens is as follows: double lumen catheter has venous lumen inside the arterial lumen, dual lumen catheter has lumens side to side. A soft, silicone rubber catheter for long-term dialysis was used first in infants and small children in the early 1980s (15). The authors reported experience with 26 catheters inserted through the left or right external or internal jugular veins into the right atrium or superior vena cava. A single-needle dialysis system was used and blood flows up to 70 ml/min The Journal of Vascular Access 2000; 1: 42-45 DIALYSIS