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Salvage of clotted jugular vein hemodialysis catheters

D Shrivastava1, A P Lundin, B Dosunmu

  • 1Renal Division, Interfaith Medical Center, Brooklyn, N.Y.

Nephron
|January 1, 1994
PubMed

Insights

Clotted jugular venous catheters (JVC) can be reopened using a guide wire technique when urokinase fails. This method successfully restored hemodialysis access in 87.5% of patients, salvaging most catheters.

Area of Science:

  • Nephrology
  • Vascular Access Management
  • Interventional Procedures

Background:

  • Jugular venous catheters (JVC) are crucial for hemodialysis in acute and end-stage renal disease.
  • Catheter clotting and occlusion frequently necessitate alternative vascular access.
  • Urokinase is effective for declotting but has high recurrence rates.

Purpose of the Study:

  • To evaluate the efficacy of a guide wire insertion technique for salvaging occluded JVCs.
  • To determine if guide wire insertion can restore patency in JVCs unresponsive to urokinase.
  • To assess the impact of this technique on facilitating continued hemodialysis.

Main Methods:

  • A cohort of 24 patients with clotted JVCs (occlusion within 6-55 days) was studied.
  • Urokinase infusion (5,000 IU) into both catheter lumens was initially unsuccessful.
  • A soft-tipped guide wire was inserted into both arterial and venous lumens of the occluded JVCs.

Main Results:

  • Guide wire insertion successfully opened occluded JVCs in 21 out of 24 patients (87.5%).
  • Immediate initiation of hemodialysis was possible in salvaged catheters.
  • The technique proved effective for JVCs unresponsive to urokinase therapy.

Conclusions:

  • Guide wire insertion is a highly effective method for salvaging urokinase-refractory occluded JVCs.
  • This technique facilitates continued hemodialysis by restoring catheter patency.
  • It offers a valuable alternative to replacing occluded JVCs, improving patient management.

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