The risk of bleeding with tunneled dialysis catheter placement

The purpose of this study was to evaluate the risk of bleeding associated with tunneled dialysis catheter (TDC) placement in a large population of hemodialysis patients who were either anticoagulated or were taking antithrombotic medications.

Medical records obtained over a two-year period were queried in order to select two groups of study cases. The first was a Med group (n = 458), cases which had a TDC placed while taking the antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid [ASA]) which were not discontinued or held. The second was a Declot Failure (DF) group (n = 941) and consisted of cases in which a TDC had been placed immediately following a failed arteriovenous access thrombectomy procedure in which they had been anticoagulated using unfractionated heparin. The results obtained in these two groups were compared to the incidence of bleeding observed in a cohort of 6555 TDC placements that had been performed previously referred to as the Control group.

The incidence of bleeding in the Control group was 0.46%. The incidence of bleeding in the DF group was 0.44% and in the Med group was 0.36%. No patient had bleeding that required transfusion, hospitalization, or catheter removal.

Based upon these data, it seems reasonable to classify the TDC placement procedure as having a very low risk of bleeding and to not require preprocedure laboratory testing. The value of suspending antithrombotic medications prior to TDC placement cannot be supported.