Tunneled central venous catheters: Experience from a single center

Area of Science:

• Nephrology
• Vascular Access
• Interventional Radiology

Background:

• Traditionally, vascular surgeons placed tunneled central venous catheters (TVCs) for hemodialysis.
• Percutaneous techniques have led to increased TVC insertion by interventional nephrologists.

Purpose of the Study:

• To audit the outcomes of 100 TVCs placed percutaneously by nephrologists over three years.
• To evaluate the efficacy and complications of TVCs as primary dialysis access, particularly for pre-transplant patients.

Main Methods:

• A single-center, three-year audit of 100 TVCs placed percutaneously by nephrologists.
• Analysis included 492 patient-months of follow-up for patients completing at least three months on catheter.
• Kaplan-Meier survival analysis was used to assess catheter patency.

Main Results:

• Catheter survival rates were 80% at 3 months and 55% at 6 months.
• Main complications included exit site ooze, blockages, and kinks; catheter-related bacteremia was low (0.4/1000 patient-days).
• TVCs provided high blood flow (250-270 ml/min) and were used as primary access in 25% of pre-transplant patients with live donors.

Conclusions:

• Tunneled central venous catheters are a viable primary access option for hemodialysis, especially for pre-transplant live donor renal transplants.
• Their immediate usability, high blood flow, low infection rates, and 3-6 month patency support their use in this patient population.