Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single‐center experience

Abstract

Introduction: As the number of elderly end‐stage renal disease patients lacking suitable vessels for arteriovenous fistula (AVF) is increasing, indications for tunnel cuffed catheters (TCCs) may be expanding. This study aimed to clarify changes over time in the number of patients with TCC and indications for TCCs. Methods: This single‐center retrospective study analyzed 143 catheters for 95 patients who inserted TCCs between July 2005 and July 2017. Patients were divided into two groups (early‐ and late‐phase groups) based on the median observational period. Demographic data and clinical information were then compared. Findings: Fifty TCCs were inserted in the early phase group, and 93 TCCs were inserted in the late‐phase group. The late‐phase group was older (77 vs. 70 years; P = 0.003) and showed a higher frequency of hypertensive nephropathy (29% vs. 14%; P < 0.05) and a lower frequency of a history of cardiovascular disease (52.7% vs. 70.0%; P = 0.045). In the late‐phase group, indications for bridge vascular access (0% vs. 11.8%; P < 0.05) or severe cardiac dysfunction (8.0% vs. 20.5%; P < 0.05) were increased. In addition, the late‐phase group showed increases in percentage of patients with the catheter inserted in the femoral vein (10.0% vs. 23.7%; P = 0.047), nephrologists performing catheter insertion (56.0% vs. 87.1%; P < 0.001), and the patients who underwent superficialization of the brachial artery (28.0% vs. 46.2%; P = 0.034). Significant differences in catheter survival, incidence of complications, reasons for catheter removal, or incidence of catheter‐related infection were not observed between groups. Discussion: Patients with indications for TCC may be increasing due to an increase in elderly end‐stage renal disease patients whose activities of daily living have decreased. In addition, indications for bridge vascular access were widely accepted in the late‐phase group.

Amino polysaccharide quaternary ammonium salt grafted to PET‐Cuff by ultraviolet irradiation for improving the sustained antibacterial property of semi‐permanent central vein tunneled cuffed catheter

“…TCC is the first choice for pediatric HD patients. 3 TCC is widely accepted by nephrologist due to its easy accessibility, but its defects are nonnegligible. Infection is the most fetal complications.…”

“…It is also applicable for patients whose blood vessels of limbs are not adequate for AVF/AVG, and patients who have high risk of AVF puncture needle removal during dialysis. TCC is the first choice for pediatric HD patients 3 . TCC is widely accepted by nephrologist due to its easy accessibility, but its defects are nonnegligible.…”

An easy way to remove a stuck hemodialysis catheter

“…The use of tunneled central venous catheters (CVCs) is common in patients with chronic renal insufficiency. 1 Tunneled CVCs are often used for temporary vascular access during arterio-venous fistula (AVF) maturation procedures. However, tunneled CVCs may have to be used for longer periods than planned in patients who are unsuitable for AVF.…”

“…However, tunneled CVCs may have to be used for longer periods than planned in patients who are unsuitable for AVF. 1 Long-term use of tunneled CVCs causes increased complications, such as catheter infections, fibrosis, central venous stenosis and vessel perforation-eventually long-term CVCs need to be replaced. However, in rare cases, CVCs cannot be removed from the central vein because the fibrin sheath is tight.…”

“…Tunneled CVCs are often used for temporary vascular access during arterio‐venous fistula (AVF) maturation procedures. However, tunneled CVCs may have to be used for longer periods than planned in patients who are unsuitable for AVF 1 . Long‐term use of tunneled CVCs causes increased complications, such as catheter infections, fibrosis, central venous stenosis and vessel perforation—eventually long‐term CVCs need to be replaced.…”