The Salvage Treatment of Accidentally Lost Tunneled Venous Catheters Using Existing Subcutaneous Tracts
Abstract
Objectives: Vascular access has prime importance in patients on hemodialysis. Tunneled dialysis catheter is one of the major types of vascular access. The most frequent tunneled hemodialysis catheter loss is due to infection and thrombosis of the catheter. Vascular access loss can be caused by accidental dislodgement of the catheter. The aim of this study was to evaluate the success rate of re-insertion of accidentally lost tunneled venous catheters using existing subcutaneous tracts.Methods and Materials: This retrospective study included 35 patients who presented with inadvertent loss of tunneled hemodialysis catheter while on a chronic hemodialysis program. The study was conducted between 2010 and 2017. With the exception of 1 patient where the time elapsed was 3 weeks, the time from catheter dislodgement to insertion of a new catheter was a mean of 18±9 hours range, 4–72 hours . The technique of allowing new catheter insertion via the existing subcutaneous tunnel is presented in this paper.Result: The technical success of the re-insertion of tunneled HD catheters via existing subcutaneous tracks was achieved in all cases. No complications were observed during the process or follow-up period.Conclusions: It was concluded that this technique has two main advantages compared to the re-insertion of the catheter to a new site. The first is that no complications were observed in any patients when the catheter was re-inserted through the subcutaneous exit site. The second advantage is that this technique takes less time, which makes the procedure more comfortable for the patient and decreases the need for sedation
Keywords
References
- Salahi H, Fazelzadeh A, Mehdizadeh A, Razmkon A, Malek-Hosseini SA. Complications of arteriovenous fistula in dialysis patients. Transplant Proc 2006;38:1261–4. [CrossRef]
- Asquith JR. Dialysis Access Management. In: Cowling MG, editor. Vascular Interventional Radiology. Medical Radiology (Diagnostic Imaging). Berlin, Heidelberg: Springer; 2007. [CrossRef]
- Aydin Z, Gursu M, Uzun S, Karadag S, Tatli E, Sumnu A, et al. Placement of Hemodialysis catheters with a technical, functional, and anatomical viewpoint. Int J Nephrol 2012;2012:302826. [CrossRef]
- Gray RJ, Levitin A, Buck D, Brown LC, Sparling YH, Jablonski KA, et al. Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well positioned tunneled central venous dialysis catheters: A prospective, randomized trial. J Vasc Interv Radiol 2000;11:1121–9. [CrossRef]
- Lorenz JM. Unconventional venous access techniques. Semin Intervent Radiol 2006;23:279–86. [CrossRef]
- Donati G, Coli L, Cianciolo G, La Manna G, Cuna V, Montanari M, et al. Thrombosis of tunneled-cuffed hemodialysis catheters: Treatment with high-dose urokinase lock therapy. Artif Organs 2012;36:21–8. [CrossRef]
- Duszak R Jr, Haskal ZJ, Thomas-Hawkins C, Soulen MC, Baum RA, Shlansky-Goldberg RD, Cope C. Replacement of failing tunneled hemodialysis catheters through preexisting subcutaneous tunnels: a comparison of catheter function and infection rates for the novo placement and over-the-wire exchanges. J Vasc Interv Radiol 1998;9:321–7. [CrossRef]
- Merport M, Murphy TP, Egglin TK, Dubel GJ. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. J Vasc Interv Radiol 2000;11:1115–20. [CrossRef]
- Resic H, Ajanovic S, Kukavica N, Coric A, Masnic F, Beciragic A. Tunneled catheter infections in patients on hemodialysis--one center experience. Acta Med Croatica 2012;66:17–21. https://hrcak. srce.hr/99534
- Izoard S, Ayzac L, Meynier J, Seghezzi JC, Jolibois B, Tolani ML. Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk Nephrol Ther 2017;13:463–9. [CrossRef]
Abstract
Amaç: Hemodiyaliz hastalarında vasküler erişim çok önemlidir. Tünelli diyaliz kateterleri en sık kullanılan vasküler erişim yollarından birisidir. Tünelli hemodiyaliz kateter kaybının en sık sebepleri enfeksiyon ve kateter trombozudur. Kateterin kazara çıkması vasküler erişim kaybının diğer önemli sebeplerinden bir tanesidir. Bu çalışmanın amacı tünelli kalıcı kateterini kazara kaybeden hastalarda mevcut subkutan tünel kullanılarak kalıcı kateterin kurtarılmasındaki teknik başarının değerlendirilmesidir. Metot ve Materyal: 2010–2017 yılları arasında kronik hemodiyaliz programındaki 35 hastada kazara tünelli hemodiyaliz kateteri kaybedilmesi sonuçu mevcut subkutan yolla tünelli diyaliz kateteri yerleştirilen hastalar retrospektif olarak değerlendirildi. Geçen sürenin üç hafta olduğu bir hasta haricinde, kateter kaybı ile yeni bir kateter yerleştirilmesine kadar geçen süre ortalama 18±9 saat 4–72 saat aralığında idi. Bu çalışmada mevcut subkutan tünel yolu kullanılarak yeni bir tünelli hemodiyaliz kateteri yerleştirilmesini sağlayan teknik sunulmaktadır. Bulgular: Mevcut subkutan tünel yolu kullanılarak yerleştirilen hemodiyaliz kateterlerinde, teknik olarak tüm işlemlerde başarı sağlandı. Hastalarımızda işlem sırasında ve takiplerde komplikasyon gözlenmedi. Sonuç: Tekniğimizin, tünelli diyaliz kateterinin yeni bir bölgeden yerleştirilmesine kıyasla iki temel avantajı olduğu sonucuna vardık. Birincisi, kateterin mevcut subkutan tünel yolundan yerleştirilmesi sırasında hastalarımızda hiçbir komplikasyonla karşılaşılmadı. İkinci avantajı ise tekniğimizin daha az zaman alması, prosedürü hasta için daha konforlu hale getirmesi ve sedasyon ihtiyacını azaltmasıdır.
Keywords
References
- Salahi H, Fazelzadeh A, Mehdizadeh A, Razmkon A, Malek-Hosseini SA. Complications of arteriovenous fistula in dialysis patients. Transplant Proc 2006;38:1261–4. [CrossRef]
- Asquith JR. Dialysis Access Management. In: Cowling MG, editor. Vascular Interventional Radiology. Medical Radiology (Diagnostic Imaging). Berlin, Heidelberg: Springer; 2007. [CrossRef]
- Aydin Z, Gursu M, Uzun S, Karadag S, Tatli E, Sumnu A, et al. Placement of Hemodialysis catheters with a technical, functional, and anatomical viewpoint. Int J Nephrol 2012;2012:302826. [CrossRef]
- Gray RJ, Levitin A, Buck D, Brown LC, Sparling YH, Jablonski KA, et al. Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well positioned tunneled central venous dialysis catheters: A prospective, randomized trial. J Vasc Interv Radiol 2000;11:1121–9. [CrossRef]
- Lorenz JM. Unconventional venous access techniques. Semin Intervent Radiol 2006;23:279–86. [CrossRef]
- Donati G, Coli L, Cianciolo G, La Manna G, Cuna V, Montanari M, et al. Thrombosis of tunneled-cuffed hemodialysis catheters: Treatment with high-dose urokinase lock therapy. Artif Organs 2012;36:21–8. [CrossRef]
- Duszak R Jr, Haskal ZJ, Thomas-Hawkins C, Soulen MC, Baum RA, Shlansky-Goldberg RD, Cope C. Replacement of failing tunneled hemodialysis catheters through preexisting subcutaneous tunnels: a comparison of catheter function and infection rates for the novo placement and over-the-wire exchanges. J Vasc Interv Radiol 1998;9:321–7. [CrossRef]
- Merport M, Murphy TP, Egglin TK, Dubel GJ. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. J Vasc Interv Radiol 2000;11:1115–20. [CrossRef]
- Resic H, Ajanovic S, Kukavica N, Coric A, Masnic F, Beciragic A. Tunneled catheter infections in patients on hemodialysis--one center experience. Acta Med Croatica 2012;66:17–21. https://hrcak. srce.hr/99534
- Izoard S, Ayzac L, Meynier J, Seghezzi JC, Jolibois B, Tolani ML. Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk Nephrol Ther 2017;13:463–9. [CrossRef]
Details
| Primary Language | English |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2020 |
| Published in Issue | Year 2020Issue: 4 |