Comparison of two venous access catheters for continuous haemofiltration in Intensive Care

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Continuous haemofiltration is performed in ICU to support patients with acute renal failure. The patient’s blood is pumped through a haemofilter where uraemic toxins are removed and then it is returned to the circulation. This is a continuous process that necessitates safe reliable large bore access to the circulation. The vascular access catheters are inserted percutaneously, usually into the femoral or internal jugular veins. There are number of commercial vascular access catheters available, but the industry standard for the past 10 years has been Bard Niagra, Bard Access Systems Inc. Utah, USA. This has large diameter channels, allowing high blood flows, but it occasionally can be difficult to insert. A new product, the Gambro Dolphin Protect, Gambro Lund Sweden, vascular access catheter has become available. It has a similar wide bore channels, but the shape of the cannula might make insertion easier and the catheter is impregnated with an antibacterial material that might reduce the rate of infection. These claimed advantages are only valuable if its basic function matches that of the industry standard. The aim of this study is to compare the two vascular access devices in a randomised controlled trial. The primary outcome measure will be trans-access resistance, a mathematically derived measure of the ease of blood flow through the catheter. Secondary outcome measures will be time to insert (in minutes) and ease of insertion measured on a visual analogue scale, presence of colonisation of the catheter at the time of removal (all tips will be sent for culture), presence of skin erythema at insertion site at time of removal, and haemofilter life (time to failure of haemofilters connected via the test cannula).

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