Costs of AKI to the NHS are £434-620m pa which includes costs of continuous haemodialysis (2). The cost of each haemodialysis kit and catheter is around 500 pounds (3). One of the most common causes of dialysis kit/catheter change before its expiry is the malfunctioned catheters.
Methods:
All patients were admitted to ITU between the periods from 1st of November, 2015 to the 1st of May, 2016 were involved in the audit. A retrospective systematic review and evaluation of records of all these patients and patients who had received continuous haemodialysis through a VasCath were selected. Twenty five cases out of 115 admissions had haemodialysis via VasCath and 40 catheters required for them, average 1.6 catheters for every patient. The maximum duration of dialysis was 7 days and minimum was 12 hrs, mean (+/- SD) 32hrs (+/- 10). 
Results:
Insertion sites: LT IJV ( 40%, femoral 25%, RT IJV 17%, LT subclavian 10%, RT subclavian 8%, survival in hours: RT subclavian 116.6 (+/- 10 SD), femoral 69.7(+/- 6.7 SD), RT IJV 69.4(+/- 7 SD), LT subclavian 40.1(+/- 3.98 SD), LT IJV 64.4(+/- 5.4 SD).Collectively: RT side 83.5(+/- 7.8 SD), LT side 59.6(+/- 5.5 SD), femoral 69.7(+/- 7 SD) hrs.Tip position in the CXR: above carina by >1 cm survived in average 45.3(+/- 4 SD), at level of carina -/+ 1 cm survived 88.9(+/- 3.98 SD) hrs, below the level of the carina > 1cm survived in average 50.5(+/- 4.32 SD) hrs. The Need for lines swap, repositioning or rewiring was in 3 out of 10 in RT side VasCath which equals 30% and in 14 out of 20 in LT side VasCath which equals 70%, six out of 10 cases of femoral VasCath which equals 60%.
Discussion:
Our findings significantly favoured right chest side and femoral haemodialysis catheters over left and catheter tip position at the level of the carina (-/+) 1 cm over far deep or superficial catheter tips. We have also observed that we unintentionally favoured left side over right side due to availability as usually patients would have right side already cannulated with a central venous catheter (CVC) before the decision for dialysis was taken and that led to change our practice and favour Lt side CVC insertion in any patient with AKI and/or potential need for dialysis and also started using the same vein dual catheter technique to obtain a vascular access and VasCath in the same vein.
References
1.	NICE guidance for central venous catheters safety and infection control procedures, 2002, TA49.
2.	AAGBI Safe Vascular Access Guidelines, May, 2016, ultrasound use for the placement of haemodialysis catheters. 
3.	Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.:CD005279, Published by John Wiley & Sons, Ltd.


03 / Side and position of haemodialysis catheters (VasCath) can affect its survival