Reinsertion of tunneled-cuffed catheter in hemodialysis patients with catheter loss and limited access options

Abstract

Purpose: Maintenance hemodialysis patients who rely on tunneled-cuffed catheters (TCCs) often face difficulty in reinserting a new catheter when the original catheter has been extruded or removed. Potential pathological changes of vessel caused by long-term indwelling of a catheter may contribute to this predicament. The aim of this study was to report and evaluate a re-catheterization technique through the same exit site and tunnel for hemodialysis patients with TCC loss. Methods: A retrospective review of 19 patients with TCC loss was conducted from January 2020 to August 2022. These patients underwent reinsertion through the same exit site and subcutaneous existing tunnel. Procedure-related complications and clinical follow-up data were collected. Results: All 19 patients with catheter loss underwent this procedure and the median duration of catheter loss was 14 days (5–57 days). Five of them had central venous occlusion, and four of them experienced catheter loss due to removal for catheter-related bloodstream infections (CRBI). In the end, 18 case received successful catheterization using this technique. The most common complication was minimal bleeding after the operation. There were no procedure-related deaths or serious complications. The average blood flow was 265.79 ± 25.89 ml/min at the end of the follow-up period. Conclusion: This maneuver is a safe and convenient technique that can be used to reinsert a TCC for patients with long-time catheter loss. It helps to preserve the limited central venous resources for patients who have difficulty establishing other stable vascular access.