Difficulty removing dialysis cuff catheter after its adhesion to the right atrium

Area of Science:

• Nephrology
• Vascular Surgery
• Internal Medicine

Background:

• Diabetic nephropathy necessitates long-term dialysis, often complicated by arteriovenous fistula (AVF) occlusion.
• Vascular access interventional therapy (VAIVT) is a common treatment for AVF occlusion.
• Cuff catheters offer an alternative vascular access method when AVF interventions fail.

Observation:

• An elderly patient with diabetic nephropathy experienced recurrent AVF occlusion, necessitating outpatient management with a cuff catheter.
• The patient developed a localized infection at the catheter site, which was successfully treated with antibiotics.
• One year post-insertion, the patient presented with dyspnea and subsequently died, with autopsy revealing catheter adhesion to the right atrium without bloodstream infection.

Findings:

• Cuff catheter insertion provided effective dialysis despite initial AVF occlusion and subsequent localized infection.
• Catheter removal was challenging due to adhesion to the right atrium, indicating potential mechanical complications.
• Autopsy confirmed no systemic infection, suggesting the catheter's role was primarily mechanical rather than infectious in the terminal event.

Implications:

• Cuff catheters can serve as a viable dialysis option for patients with complex vascular access issues.
• Physicians should be aware of potential mechanical complications, such as right atrial adhesion, associated with long-term cuff catheter use.
• This case underscores the importance of careful monitoring and management of patients undergoing long-term dialysis via cuff catheters.