Modified over-the-wire technique for infected tunneled cuffed dialysis catheters exchange: a precious salvage procedure
DOI:
https://doi.org/10.18203/2349-2902.isj20183186Keywords:
End-stage-renal-disease, Hemodialysis, Infection, Over-the-wire technique, Tunneled cuffed dialysis catheterAbstract
Background: One of the major troubles related to tunnelled cuffed catheters for hemodialysis is infection. The outcomes of conservative treatment, as an attempt to access salvage, are often poor.
Methods: In the present retrospective study, authors reviewed all the patients who underwent infected tunneled cuffed dialysis catheter exchange through a modified over the wire technique. Briefly, this technique consisted in creating a new subcutaneous tunnel away from the old one, preserving the insertion site of the catheter to the vein.
Results: Authors have performed infected catheter exchange with this technique in 59 patients. The success rate was 93.2%. Median follow-up was 9 months. There were only 4 patients with signs and symptoms of recurrent catheter infection treated with catheter removal.
Conclusions: The modified technique may provide multiple benefits for patients with ESRD. Low recurrence rates, anatomic site preservation and cost effectiveness are some of the advantages of this technique.
References
Ethier J, Mendelssohn D, Elder S, Hasegawa T, Akizawa T, Akiba T et al. Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant. 2008;23:3219-26.
Kidney Disease Outcomes Quality Initiative: Clinical Practice Guidelines and Clinical Practice Recommendations, 2006 Updates, Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, Vascular Access. Available at: http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/index.htm.
Trerotola SO, Johnson MS, Harris VJ, Shah H, Ambrosius WT, McKusky MA et al. Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologists. Radiol. 1997;203:489-95.
Marr KA, Sexton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB. Catheter – related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997;127:275-80.
Beathard GA. Management of bacteremia associated with tunneled – cuffed hemodialysis catheters. J Am Soc Nephrol. 1999;10:1045-9.
Tanriover B, Carlton D, Saddekni S, Hamrick K, Oser R, Westfall AO et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int. 2000;57:2151-5.
Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO. Tunneled hemodialysis catheter bacteremia: risk factors for bacteremia recurrence, infectious complications and mortality. Nephrol Dial Transplant. 2006;21:1024-31.
Saad TF. Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis. 1999;34:1114-24.
Trerotola SO. Hemodialysis catheter placement and management. Radiol. 2000;215:651-8.
Alomari AI, Falk A. The natural history of tunneled hemodialysis catheters removed or exchanged: a single-institution experience. J Vasc Interv Radiol. 2007;18:227-35.