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

Abstract

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.

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

“…The procedure was usually well tolerated by the patients with minimal discomfort. Most catheters (∼75–90%) were removed, as expected, from the internal jugular vein location (predominantly on the right) . While we did not specifically collect information on exit site infection observed after TDC removal, anecdotally we could not recall one from our series.…”

“…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 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%) .…”

“…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%) . Indications for removal were strongly associated with the setting of removal; whereas access maturation was the predominant reason for outpatient TDC removals , catheters in the inpatient setting were commonly removed for proven or clinically suspected infections .…”

“…Indications for removal were strongly associated with the setting of removal; whereas access maturation was the predominant reason for outpatient TDC removals , catheters in the inpatient setting were commonly removed for proven or clinically suspected infections . Exit site infection alone was an infrequent (<2%) indication for catheter removal . Information on duration of use was limited to the VA series, with mean length of 164 days but with a wide variation among subjects (standard deviation ±162 days) .…”