The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees

Fülöp, Tibor; Tapolyai, Mihály; Qureshi, Naseem A.; Beemidi, Vikram R.; Gharaibeh, Kamel A.; Hamrahian, Seyed Mehrdad; Szarvas, Tibor; Kövesdy, Csaba P.; Csongrádi, Éva

doi:10.3109/0886022x.2013.823875

Cited by 12 publications

(36 citation statements)

References 22 publications

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“…We were left with 30 (41%) articles after applying the exclusion and inclusion criteria. Six articles were related to student learning (3)(4)(5)(6)(7)(8), five were related to postgraduate trainees (9-13), and 19 were related to fellows or fellowship training (1,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). None of the articles had teachers or faculty members as subjects of the educational investigation.…”

Section: Literature Searchmentioning

confidence: 99%

Nephrologists as Educators

Jhaveri

Perazella

2016

Clinical Journal of the American Society of Nephrology

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Nephrologists play an important role in providing medical education in a variety of settings, including the medical school classroom, nephrology consult service, outpatient clinic, and dialysis unit. Therefore, nephrologists interact with a variety of learners. In this article the current state of published literature in medical education in nephrology is reviewed. Eight attending roles are identified of the nephrologist as a medical educator in the academic settings: inpatient internal medicine service, nephrology inpatient consult service, inpatient ESRD service, outpatient nephrology clinic, kidney transplantation, dialysis unit, classroom teacher, and research mentor. Defining each of these distinct settings could help to promote positive faculty development and encourage more rigorous education scholarship in nephrology.

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Section: Literature Searchmentioning

confidence: 99%

Nephrologists as Educators

Jhaveri

Perazella

2016

Clinical Journal of the American Society of Nephrology

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Section: Methodsmentioning

confidence: 99%

“…The authors' combined nonoverlapping individual experience now spans over 45 years and probably more than 650 TDC removal procedures, of which a large part now has been reported ( ). These included a cohort of 55 predominantly inpatients , 138 mixed in‐ and outpatients , and 72 patients from a Veterans Affairs (VA) Medical Center's Unit (Table ). The main indications for TDC removal in our published cohorts included permanent access maturation or recovery of renal function (52–76%) , infection or documented access‐related bacteremia in (∼30%), or clinical evidence of sepsis or infection (∼15%) .…”

Section: Methodsmentioning

confidence: 99%

“…Nonetheless, they represent an inferior access modality compared with conventional AV fistulas and grafts and their utilization is associated with increased mortality . The current literature on TDCs is focused around circumstances of placement , malfunction and maintenance of catheter patency , as well as prevention of infections . Approximately two‐thirds of them would ultimately need to be removed due to either malfunction or infectious complications .…”

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confidence: 99%

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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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“…In these cases, if infection suspect, it is enormously important to remove these devices as soon as possible. In fact, some of these tunneled-cuffed accesses can be removed at bedside [121] . Finally, the need for dialysis or hemapheresis in the adult critically ill patient is still an absolute indication to a CICC, as no double lumen PICC appears to be useful in this regard.…”

Section: Hemodialysis Cathetersmentioning

confidence: 99%

Focus on peripherally inserted central catheters in critically ill patients

Cotogni

Pittiruti

2014

WJCCM

100

105

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Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e. , low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. 80November 4, 2014|Volume 3|Issue 4| WJCCM|www.wjgnet.com access devices (CVADs) are key elements of management for either adult or pediatric critically ill patients. Healthcare pro...

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The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees

Abstract: Our results suggest that bedside removal of TDC remains a safe and effective procedure regardless of site or indications. Accordingly, TDC removal should be an integral part of competent Nephrology training.

Cited by 12 publications

References 22 publications

Nephrologists as Educators

Nephrologists as Educators

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

Focus on peripherally inserted central catheters in critically ill patients

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