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Purse-string suture to prevent bleeding after tunneled dialysis catheter insertion
Andrew Kerr1, Radhika Pathalapati, Shi Qiuhu
1Department of Radiology, New York Medical College-Metropolitan Hospital, New York, New York 10029, USA. andrewkerra@nychhc.org
Insights
Placing a purse-string suture during tunneled dialysis catheter (TDC) insertion significantly reduced postprocedural bleeding. This simple technique nearly eliminates bleeding complications, improving patient outcomes.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Postprocedural bleeding is a common complication following tunneled dialysis catheter (TDC) insertion.
- Minimizing bleeding is crucial for patient comfort and preventing further complications.
Purpose of the Study:
- To evaluate the efficacy of purse-string sutures at the tunnel exit site in reducing postprocedural bleeding after TDC insertion.
Main Methods:
- A retrospective study compared 51 patients without purse-string sutures (control) to 50 patients with purse-string sutures (experimental) at the TDC tunnel exit site.
- Outcomes assessed included postprocedural bleeding noted in charts, plasma hemoglobin levels, and need for blood transfusions within 5 days.
Main Results:
- A significantly lower incidence of postprocedural bleeding was observed in the experimental group (6%) compared to the control group (25.4%, P = .0124).
- No patients in the experimental group required prolonged compression, while 6% in the control group did.
- Mean hemoglobin decrease was not significantly different between groups, nor was the rate of red blood cell transfusion.
Conclusions:
- Routine placement of purse-string sutures at the tunnel exit site during TDC insertion is an effective method to significantly decrease postprocedural bleeding.
- This minor technical modification can substantially reduce bleeding complications associated with TDC placement.
Purpose:
To determine whether placing a purse-string suture at the tunnel exit site at the time of tunneled dialysis catheter (TDC) insertion will decrease postprocedural bleeding.
Materials And Methods:
In a retrospective single-center, single-operator study, 51 patients in the control group had TDCs inserted without purse-string sutures at the tunnel exit site and 50 patients in the experimental group had TDCs inserted with purse-string sutures at the tunnel exit site. The patients' charts were evaluated for postprocedural progress notes describing bleeding, plasma hemoglobin levels before and after catheter insertion, and transfusion of packed red blood cells in the first 5 days after catheter insertion.
Results:
Thirteen patients in the control group (25.4%) and three patients in the experimental group (6%) had postprocedural chart notes describing bleeding. The difference between the two groups was highly significant (P = .0124). Six percent of patients in the control group and none of the patients in the experimental group required prolonged compression or compression dressing placement after catheter insertion. There was a significant mean hemoglobin decrease of 0.3 g/dL after catheter insertion in the control group and an insignificant mean hemoglobin decrease of 0.1 g/dL in the experimental group. The difference in hemoglobin decrease between the two groups was not significant. The difference in the number of patients requiring transfusion in the 5 days after catheter insertion (eight of 51 vs nine of 50) was not significant.
Conclusions:
Venous bleeding after TDC insertion is a complication that merits attention. Routine purse-string suture placement at the tunnel exit site is a minor change in standard technique that can nearly eliminate this problem, as reflected in postprocedural chart notes.
