Subcutaneous Cuff Migrates after Initiation of Peritoneal Dialysis

Sakurada, Tsutomu; Kotake, Hitoshi; Koitabashi, Kenichiro; Shibagaki, Yugo

doi:10.3747/pdi.2017.00196

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…The term cuff extrusion (CE) encompasses all cases where the Dacron cuff is visible outside the tunnel, either completely or partially, and includes those cases where the entire catheter is outside the body (catheter fall-out). This noninfectious complication is well documented for peritoneal dialysis catheters 2,3 and its incidence has been reported for hemodialysis catheters in pediatric populations with incidence of up to 25% 4 and a rate of 2.4 episodes/1,000 catheter-days. 5 For adult patients, although it has been previously mentioned in the literature, [6][7][8][9] it has never been the focus of attention and some publications do not discuss it as a possible complication.…”

Section: Introductionmentioning

confidence: 96%

Factors Affecting Cuff Extrusion of Tunneled Hemodialysis Catheters

et al. 2021

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Purpose: To identify patient and procedural factors associated with extrusion of the Dacron cuff from the subcutaneous tunnel of tunneled hemodialysis catheters (THDCs). Materials and methods: Single center 5-year retrospective analysis of 625 catheters in 293 adult patients. Patient data included age, gender, body mass index (BMI), and common comorbidities. Procedural details included type of procedure (new insertion vs. exchange), operator seniority, side of insertion, catheter model and presence of catheter wings skin-sutures. Complications were reported as cumulative risk over time and Cox proportional hazards model was used to evaluate risk factors for cuff extrusion (CE). Results: Median patient follow-up was 503 days (188,913 catheter-days) and median catheter survival 163 days. CE occurred in 23.8% of catheters, at a rate of 0.79 per 1,000 catheter-days and a median time of 64 days. It was more common than infection (14.6%) and inadequate flow (15.5%). The 1-month and 12-month risk of CE was 5.9% and 21.3% respectively. A first episode of CE was a strong predictor of future CE episodes. The only patient factor that affected the risk of CE was BMI (Hazard Ratio 2.36 for obese patients). Procedural factors that affected the risk of CE, adjusted for BMI, were catheter model, type of procedure (lower risk for new insertions) and catheter wings skin-sutures; the latter reduced the 30-day CE risk by 76% without increasing catheter-related infections. Conclusion: Cuff extrusion is common in long-term THDCs. The risk increases with obesity, history of previous cuff extrusion, certain catheter models and absence of wing-sutures.

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Section: Introductionmentioning

confidence: 96%

Factors Affecting Cuff Extrusion of Tunneled Hemodialysis Catheters

et al. 2021

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“…Cuff extrusion has also been reported in peritoneal dialysis catheters [3,4]. In a recent study of the adult population, it was observed that the risk of cuff extrusion in dialysis patients increased with obesity, a history of previous cuff extrusion, certain catheter models, and the absence of wing sutures.…”

Section: Introductionmentioning

confidence: 98%

Etiological Factors Affecting Single Versus Multiple Tunneled Hemodialysis Catheter Cuff Extrusions in the Saudi Population

Raza,

Hashmi,

Khan

et al. 2024

Cureus

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Objective: To identify underlying factors associated with single versus multiple expulsions of tunneled hemodialysis catheter cuffs and their associated complications.Materials and methods: A multicenter, five-year retrospective data analysis was conducted on hemodialysis patients with tunneled catheters. Patient data included age, gender, BMI, and associated comorbidities. The type of procedure (new tunnel insertion vs. exchange), exit site infection, and catheter-related bloodstream infection (CRBSI) were also included.Results: The data of 122 patients was analyzed. Seventy-eight patients had diabetes mellitus, 102 patients had hypertension, and 24 had ischemic heart disease. Fifty-one patients were on antiplatelet therapy, and nine patients were on oral steroids. The access site for 98 patients was the right internal jugular; for 19 patients, it was the left internal jugular; five patients had a femoral dialysis catheter. Patients were grouped into two categories: those with single cuff extrusion episodes and those with multiple cuff-out episodes. Sixty-three patients had one cuff extrusion, and 59 had multiple cuff-out episodes during the study period. Patients who had CRBSI and hypertension and were aged between 61 and 95 had multiple episodes of cuff extrusion and reached statistical significance. Exit-site infection, diabetes mellitus, antiplatelet therapy, gender, catheter site, and BMI had no statistical significance between the two groups.Conclusion: Tunneled catheter cuff extrusion is a frequent phenomenon. Catheter-related bloodstream infection, hypertension, and age of 61 to 95 years are high-risk factors for multiple episodes of cuff extrusion.

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Catheter Exchange With Elongation of Tunnel (CEET) Procedure—A Novel Technique for Cuff Extrusion of Tunneled Dialysis Catheter: Surgical Experience and Early Outcomes

Behera,

Mehta,

Vishwanath

et al. 2024

Seminars in Dialysis

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BackgroundCuff extrusion of tunneled dialysis catheter (TDC) leads to catheter dysfunction, leading to loss of vascular access and the need for new catheter. Definitive management is to remove TDC and reinsert new catheter by new venous puncture and tunnel, which may not be possible in all cases. The study evaluated the surgical experience and early outcomes of a novel “Catheter Exchange with Elongation of Tunnel (CEET)” procedure for cuff extrusion.MethodsThe retrospective study included all cases of hemodialysis with TDC with partial or complete cuff extrusion and excluded complete catheter dislodgement, tunnel infection, or any catheter related infection. All patients also underwent the CEET procedure under fluoroscopy guidance, and the clinical details and outcomes were analyzed.ResultsEleven cases of TDC cuff extrusion underwent the CEET procedure of which three (27.2%) had previous and four (36.4%) had partial cuff extrusion, and seven cases (63.6%) had short tunnel length, which likely predisposed to cuff extrusion. CEET procedure was successful in 10 cases (success rate 90.1%) with desired position of catheter tip and good blood flow. Study population was divided into early and late cuff extrusion (≥1 month). Short tunnel length was associated with late extrusion (p = 0.05), whereas premature removal of TDC anchor sutures was associated with early cuff extrusion (p = 0.04).ConclusionCEET procedure is a successful alternative technique for correction of cuff extrusion of TDC with good success rate. Premature removal of anchor sutures was associated with early cuff extrusion, whereas short tunnel length was associated with late cuff extrusion.

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Subcutaneous Cuff Migrates after Initiation of Peritoneal Dialysis

Cited by 3 publications

References 10 publications

Factors Affecting Cuff Extrusion of Tunneled Hemodialysis Catheters

Factors Affecting Cuff Extrusion of Tunneled Hemodialysis Catheters

Etiological Factors Affecting Single Versus Multiple Tunneled Hemodialysis Catheter Cuff Extrusions in the Saudi Population

Catheter Exchange With Elongation of Tunnel (CEET) Procedure—A Novel Technique for Cuff Extrusion of Tunneled Dialysis Catheter: Surgical Experience and Early Outcomes

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