Outcomes of Tunneled Dialysis Catheter In Hemodialysis Patients In A Tertiary Care Hospital

BACKGROUND: To evaluate tunnel dialysis catheter (TDC) patency and its outcome among patients receiving TDC in a tertiary care hospital.METHODS: Retrospectively patients’ records were reviewed who underwent TDC placement during February 2016 to November 2020 at Department of Interventional Radiology, Liaquat National Hospital, Karachi, Pakistan. Patients’ age, gender, residence, comorbidity, catheter placement site, use of antibiotics before catheter insertion, reasons for catheter removal and total catheter days were retrieved from patients’ medical record file.RESULTS: 130 patients received TDC with a median follow-up of 148 (inter-quartile range: 60.8 – 274.3) days. 94(72.3%) catheters were electively removed whereas 18(13.8%), 16(12.3%) and 2(1.5%) catheters were removed due to infections, blockage and physical damage respectively. None of the mortality was observed due to catheter related complication. The incidence of overall infection, bacteremia and other infections during one year was 7.3, 5.01 and 3.19 per 10,000 patient-days respectively. Infection free survival rate was 68% with mean time to infection was 676.63 (95% CI: 593.87 – 759.39) days. During the study, total catheter patency was 53.2%. None of the patients’ characteristics was associated with catheter related infections and catheter patency.CONCLUSION: TDCs are the best available alternative for short to intermediate term use for hemodialysis when all preventive measures are taken to avoid catheter related complications either infectious or non-infectious until permanent dialysis access is achieved or renal transplant is done. It may also serve as long term hemodialysis mode in patients in whom permanent access or transplant is not preferred.

Percutaneous insertion of peritoneal dialysis catheters by the nephrologist (modified Seldinger technique)

A proper functioning access to the peritoneal cavity is the first and foremost requirement to start peritoneal dialysis. Most commonly, peritoneal dialysis catheters are inserted using a surgical approach. Laparoscopic peritoneal dialysis catheter insertion is the recommended surgical technique because it offers to employ advanced adjunctive procedures that minimize the risk of mechanical complications. In patients with low risk of mechanical catheter complications, such as patients without prior history of abdominal surgery or peritonitis, and in patients ineligible for general anesthesia, the percutaneous approach of peritoneal dialysis catheter insertion is an alternative to surgical catheter insertion. Percutaneous insertion of peritoneal dialysis catheters can be performed by a dedicated nephrologist, interventional radiologist, surgeon or nurse practitioner under local anesthesia, either with or without image guidance using ultrasound or fluoroscopy. Several reports show similar catheter function rates, mechanical and infectious complications and catheter survival for percutaneously inserted peritoneal dialysis catheters compared to surgically inserted peritoneal dialysis catheters. This article describes the percutaneous insertion of peritoneal dialysis catheters technique adopted at Universitair Ziekenhuis Brussel since 2015. Our technique is a simple low-tech modified Seldinger procedure performed by the nephrologist and not using fluoroscopy guidance. We describe the excellent outcomes of our percutaneously inserted peritoneal dialysis catheters and offer a practical guide to set up your own percutaneous catheter insertion program.

Budd-Chiari syndrome: An unusual complication of an internal jugular tunneled dialysis catheter

Budd-Chiari syndrome due to the tip of an internal jugular tunneled dialysis catheter malposition in inferior vena cava or hepatic vein is a rare complication. We aimed to present our experience and compare it with the previous reports to highlight the clinical features and the optimal management. A 57-year-old female with history of ANCAp vasculitis, treated by hemodialysis in the last 2 years on a right internal jugular vein tunneled catheter was admitted for pain in the right upper quadrant. A subacute Budd-Chiari syndrome due to catheter malposition was diagnosed. The catheter was removed, and a new tunneled hemodialysis line was inserted in the right internal jugular vein with the tip at the junction of right atrium with superior vena cava. Anticoagulation with apixaban 2.5 mg twice daily was started after catheter replacement and the patient was discharged. At 1 month follow-up the patient had no symptoms, and the ultrasound revealed the absence of the thrombus in the inferior vena cava. Imagining monitoring for malposition after insertion or in a clinical context suggestive for Budd-Chiari syndrome is essential for early diagnosis and treatment. In our case, anticoagulation with apixaban and prompt catheter replacement resulted in Budd-Chiari syndrome resolution.