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Tunneled catheters in hemodialysis: Indications and complications
B A Chouhani1, N Kabbali1, S Chiba Bennani1
1Nephrology, dialysis and transplantation department, Hassan II University Hospital, Fez, Morocco; Laboratory of Epidemiology and Health Science Research (ERESS), Faculty of Medicine-Fez, Sidi-Mohammed-Ben-Abdellah University, Fez, Morocco.
Insights
Tunneled central venous catheters (TCVC) are a viable option for hemodialysis patients when arteriovenous fistulas (AVF) are not feasible. While initial complications are often minor, delayed issues like infections and thrombosis require attention, with AVF maturation being the primary reason for catheter removal.
Area of Science:
- Nephrology
- Vascular Access
- Medical Devices
Background:
- Tunneled central venous catheters (TCVC) serve as a critical alternative vascular access for hemodialysis when arteriovenous fistulas (AVF) are not immediately available or feasible.
- Placement by nephrologists offers a practical solution for managing patients awaiting AVF maturation or requiring unscheduled dialysis.
Purpose of the Study:
- To report the experience of nephrologists in placing TCVC in hemodialysis patients.
- To establish the indications, complications, and lifespan of TCVC in this patient population.
Main Methods:
- A retrospective, descriptive, and analytical study was conducted in a nephrology department.
- Data from 138 patients who received TCVC between June 2018 and June 2020 were analyzed.
- Complications, indications, and catheter lifespan were evaluated, with statistical analysis of risk factors.
Main Results:
- The primary indication for TCVC placement was pending AVF maturation (34.6% due to Glomerular Nephropathy).
- Periprocedural complications occurred in 46% of cases, mostly mechanical and hemorrhagic, and were generally benign.
- Delayed complications included infectious (56.5%) and thrombotic (43.5%) issues, with higher rates in women and linked to factors like hemodialysis seniority, heart disease, and anemia.
Conclusions:
- TCVC placement by nephrologists is effective for hemodialysis access, particularly when AVF is pending.
- While immediate complications are usually minor, delayed infectious and thrombotic complications are significant concerns.
- The average lifespan of TCVC was limited, primarily due to successful AVF maturation leading to catheter removal.
Objective:
Tunneled central venous catheters (TCVC) are a good alternative in case that an arteriovenous fistula (AVF) cannot be made, awaiting maturation or during unscheduled hemodialysis. We report the experience in placing these catheters by nephrologists and establish the various indications and complications in hemodialysis patients. We also relate the lifespan of tunneled catheters in our series.
Materials And Methods:
Our study is a retrospective, descriptive and analytical, study carried out in nephrology department, including all the patients who benefited from a TCVC between June 2018 to June 2020. We included a total of 138 patients, Glomerular nephropathy was the main cause of end stage renal disease (ESRD) (34.6%). In total, 116 patients previously had an AVF. The average duration of use of TCVC was 140.62 days±106.104 [10-548 days]. The most frequent indication for placement of the tunneled catheter was pending for AVF to be made. We identified 64 (46%) cases who presented with complications per procedure (mechanical and hemorrhagic), the delayed complications were present in 12.3% of patients with 56.5% who presented with infectious complications in our series, and 43.5% of them experienced thrombotic complications. Two deaths in our series were related to a septic shock and a hemothorax. Mechanical and thrombotic complications occurred more frequently in women (P=0.032, P=0.018, respectively). For bleeding complications, the significant risk factor during our study was thrombocytopenia (P=0.027). Infectious complications, were linked to seniority in hemodialysis (P=0.014). Thrombotic complications were related to history of heart disease and anemia<8g/dL (P=0.01; P=0.043, respectively).
Conclusion:
The first indication of a CVC was a pending for AVF. Even if the per procedure complications were more frequent, they were benign in most cases. The delayed complications were mostly infectious and thrombotic. The lifespan of TCVC in our series was short since the main indication of the removal was the maturation of an AVF.
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