Outcome of Polyester Cuff Retention Following Traction Removal of Tunneled Central Venous Catheters

Kohli, Marc D.; Trerotola, Scott O.; Namyslowski, Jan; Stecker, Michael S.; McLennan, Gordon; Patel, Nilesh H.; Johnson, Matthew S.; Shah, Himanshu; Seshadri, Roopa

doi:10.1148/radiology.219.3.r01jn05651

Cited by 31 publications

(37 citation statements)

References 7 publications

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“…Removal of TDC's could take place in a variety of settings, including a dedicated procedure suite by surgeons, interventional radiologists or interventional nephrologists, or by a nephrologist at the bedside. While removal of TDC is relatively well described in the setting of dedicated “proceduralist” services and this procedure may often be practiced by physicians in private practice, there is very little reported on the safety and efficacy of this procedure during bedside removals . Nephrologists are ideally suited to determine the optimal timing of removal, but most Renal Fellowships do not offer formal procedural training in Interventional Nephrology.…”

mentioning

confidence: 99%

Tunneled Hemodialysis Catheter Removals by Non‐Interventional Nephrologists: The University of Mississippi Experience

Fülöp

Rodríguez

Kosztaczky

et al. 2015

Seminars in Dialysis

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Bedside removal of tunneled hemodialysis catheters (TDC) by noninterventional Nephrologists has not been frequently performed or studied. We performed a retrospective review of bedside TDC removal at the University of Mississippi Medical Center between January, 2010 and June, 2013. We collected data on multiple patients and procedure-related variables, success, and complications rates. Of the 138 subjects, mean age was 50 (±15.9) years, 49.3% were female, 88.2% African American and 41% diabetics. Site of removal was the right internal jugular (IJ) in 76.8%, the left IJ in 15.2%, and the femoral vein in 8% of patients. Exactly 44.9% of removals took place in the outpatient setting. Main indications for the removal were proven bacteremia in 30.4%, sepsis or clinical concerns for infection in 15.2% of the cases, while TDC was no longer necessary in 52.2% of patients. All removals were technically successful and well tolerated, but we observed Dacron "cuff" separation and subcutaneous retention in 6.5% of the cases. There was a significant association between outpatient removal and cuff retention (p = 0.007), but not with the site of removal or operator experience. In this relatively large mixed cohort of inpatients and outpatients, bedside TDC removal was well tolerated with a minimal complication rate.

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mentioning

confidence: 99%

Tunneled Hemodialysis Catheter Removals by Non‐Interventional Nephrologists: The University of Mississippi Experience

Fülöp

Rodríguez

Kosztaczky

et al. 2015

Seminars in Dialysis

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“…Additionally, none of us have encountered catheter tears during extraction of dual‐lumen catheters. Very importantly, however, single‐lumen twin dialysis catheters (i.e., Tesio, MedComp) are reported to fracture very easily and are not suitable for traction removal (brand not encountered in our series). In case of catheter tear, clamp compression of the remaining catheter fragment would be mandatory to prevent bleeding or air embolism during removal .…”

Section: Discussionmentioning

confidence: 78%

Bedside Tunneled Dialysis Catheter Removal-A Lesson Learned From Nephrology Trainees

et al. 2016

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Semi-permanent dual-lumen tunneled (or tunneled-cuffed) hemodialysis catheters (TDC) are increasingly utilized during renal replacement therapy, while awaiting permanent access maturation or renal recovery. Although there is a wealth of literature focused on placement, infection prevention, and maintenance of catheter patency, circumstances and indications for TDC removal are less well understood. Timely removal of these catheters is an important management decision, with the length of TDC duration representing the largest cumulative risk factor for catheter-associated blood stream infections. Waiting for assistance from surgical or radiological services-which may not be available in all hospitals-may result in delays in services and potential harm to the patients. Imparting and maintaining procedural skills to remove infected TDC may be very valuable for training programs in clinical nephrology. In this article the current literature on bedside TDC removal, including potential anticipated complications during removal, are reviewed. To date, the authors have documented successful implementation of bedside TDC removal in training programs from two different settings, including both in- and outpatients and with trainee involvement. In summary, training general nephrologists for bedside TDC removal will afford immediate removal of infected hardware in ill patients and avoid potential delays in outpatient setting.

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“…The resultant catheter‐related bacteremias, in addition to catheter thrombosis leading to dysfunction, are major indicators of catheter removal. Catheter removal is traditionally performed by manual dissection and traction, which may result in cuff retention in 10% of the patients (3). Although cuff retention is usually inconsequential, it may serve as a potential locus for infection in some cases (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…Fibrous tissue grows in and around the cuff, and the catheter helps to prevent accidental withdrawal of the catheter (2). Catheter removal is traditionally carried out by manual dissection and traction (3) or by a cutdown (4,5). The initial and preferred technique is manual dissection and traction, but may result in cuff retention in as much as 10% of cases (3).…”

Section: Patient Demographicsmentioning

confidence: 99%

“…Catheter removal is traditionally carried out by manual dissection and traction (3) or by a cutdown (4,5). The initial and preferred technique is manual dissection and traction, but may result in cuff retention in as much as 10% of cases (3). Although cuff retention is usually inconsequential, it may serve as a potential locus for infection and catheter manufacturers continue to advise that all catheter cuffs should be removed in their entirety.…”

Section: Patient Demographicsmentioning

confidence: 99%

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Avoiding a Cutdown—Use of the Transcatheter Extractor in Removal of Tunneled Dialysis Catheters

Niyyar

Work

2011

Seminars in Dialysis

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The purpose of our study was to evaluate the use of a transcatheter extractor (TCE) device in removing cuffed tunneled dialysis catheters without a surgical cutdown. We report eight cases where a TCE was used to successfully remove cuffed tunneled dialysis catheters through the exit site that would have otherwise required a second incision. The cuff was above the clavicle in all cases and varied 3-5 cm from the exit site. The method included inserting the device over the catheter through the exit site and engaging it over the cuff. A to-and-fro motion was then used in the same plane as the catheter to dissect the cuff from the surrounding tissue. Once the cuff was freed, the catheter was removed easily without resistance. The fibrous cuff was removed intact in all cases. We conclude that the use of this device may help avoid a cutdown and minimize trauma to the patient. It is an effective technique to remove tunneled dialysis catheters and is particularly useful in catheters with ingrown cuffs further from the exit site.

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Outcome of Polyester Cuff Retention Following Traction Removal of Tunneled Central Venous Catheters

Abstract: Traction removal of smaller-bore silicone catheters is more likely to result in cuff retention than removal of larger silicone and polyurethane catheters, and cuff retention is usually inconsequential.

Cited by 31 publications

References 7 publications

Tunneled Hemodialysis Catheter Removals by Non‐Interventional Nephrologists: The University of Mississippi Experience

Tunneled Hemodialysis Catheter Removals by Non‐Interventional Nephrologists: The University of Mississippi Experience

Bedside Tunneled Dialysis Catheter Removal-A Lesson Learned From Nephrology Trainees

Avoiding a Cutdown—Use of the Transcatheter Extractor in Removal of Tunneled Dialysis Catheters

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