[Tunneled catheters. Complications during insertion]

The creation of vascular accesses for hemodialysis in patients affected with terminal kidney failure affections, is presented periodically as a problem. Because of it, the availability of alternatives to the arteriovein fistula is something necessary; different types of tunnelled dialysis catheters are being developed, among which the Tesio catheter is the most well known and most widely utilized. Often it is implanted by vascular surgeons or radiologists; this creates dependence for the nephrology services that can delay obtaining the new vascular access and initiating or reinitiating the treatment.

A descriptive study with the objective of analyzing the immediate complications during the insertion of tunnelled central catheters for hemodialysis and to evaluate the possibility of its attainment was carried out by nephrologists and personnel specialized in dialysis. Between January of 2003 and December of 2005, 175 Tesio tunnelled central catheters were implanted in our hemodialysis unit. Age and sex of the patient was registered, time in dialysis, diagnosis of hypertension, diabetes mellitus or prior heart disease, previous anticoagulant or platelet antiaggregate treatment, difficulty perceived by the nephrologist for the development of the technique, bleeding, systolic and diastolic arterial pressure, cardiac frequency, oxygen saturation and changes in the monitoring of electrocardiogram, at the beginning of the intervention, during the channelling of the vein, insertion of the dilatators and catheter, and at the end of it.

The patients were 88 men and 82 women, with an average of age of 64. 21% of the patients habitually followed a treatment with platelet antiaggregate or anticoagulant, which had been withdrawn in the prior days. The ultrasound size of the vein was greater than one cm in 79% of the cases. Of 175 insertions only three patients (2%) presented signs of hemodynamic instability, two of them due to a descent of arterial tension and one by oxygen saturation descent; none of them required assisted backup, neither hemorrhage nor other complications appeared.

The implant of tunnelled catheters, under local anesthesia, presents minimal complications and incidents during its insertion. It can be carried out by a nephrologist and specialized personnel, in hospitals with backup units that can undertake any possible complications.