Conversion of Temporary Hemodialysis Catheters to Permanent Hemodialysis Catheters: A Retrospective Study of Catheter Exchange versus Classic de novo Placement

Abstract

Many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) catheters to long-term or permanent catheters. However, since vascular access sites are at a premium in the dialysis patient, it is important to preserve existing central venous catheters and conserve future access sites. In this retrospective study, data from 94 patients referred to interventional radiology for placement of long-term, tunneled HD catheters between July 2001 and September 2002 were reviewed. The study group consisted of 42 patients in whom the temporary catheter was exchanged for a peel-away sheath and a tunneled catheter inserted using the existing venous access site. The control group included 52 patients who received traditional de novo placement of permanent catheters. Based on available follow-up data, we report a 100% technical success rate, with 72% patency at 30 days in the study group (n = 32; mean age 58 years). By comparison, de novo catheter placement (n = 35; mean age 59 years) yielded a 100% technical success rate, with 83% patency at 30 days. The overall infection rate was 0.30 per 100 catheter-days (total 3036 catheter-days) and 0.36 per 100 catheter-days (total 3295 catheter-days), respectively (chi2 = 0.64, p > or = 0.05). There was no incidence of exit site infection, tunnel infection, or florid sepsis in either group. Likewise, no stenosis or bleeding complication was noted. Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.

Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

“…Therefore, overall infection risk due to this specific procedure reported by this study and other studies 8,[15][16][17] is similar to that of de novo catheter placement.…”

“…Other studies have reported similar infection rates, ranging from 1.0 to 1.1 infections/1,000 catheter-days. [13][14][15] Falk et al 16 have reported even higher 30-day infection incidence (9.4%) and rate (3/1,000 catheter-days). Recently, Bajaj et al 17 have…”

“…Other studies have reported patency rates varying from 42% to 83%. 14,16,21,22 This suggests that relying on previous thorax X-ray to estimate the catheter tip position might be an interesting option when fluoroscopy is not available. Also, not placing TCC when venotomy is too high (.3 cm from the clavicle, in our protocol) is another important measure for avoiding catheter kinking and, therefore, promoting better catheter patency.…”

“…Other studies have also reported low complication index. 8,13,15,16,21 Even though we did not use fluoroscopy in our procedures for limitations of our service, the importance of having an interventional radiology or vascular backup team must be highlighted in order to deal with the complications that cannot be managed by nephrologists.…”

Air Embolism during Insertion and Replacement of Tunneled Dialysis Catheters: A Retrospective Investigation of the Effect of Aerostatic Sheaths and Over-the-Wire Exchange

“…Although in vitro testing has shown benefits with aerostatic sheath use, there are few clinical data investigating the risk of AE events during tunneled catheter placement with aerostatic sheaths (3,4). Additionally, over-the-wire exchange (OTWE) has become a standard of care in tunneled dialysis catheter (TDC) management as a means to preserve venous access, but little is known about the incidence of AE during OTWE (5)(6)(7)(8). The purpose of this study was to determine the effect of aerostatic sheaths on AE events during insertion of TDCs and to characterize such events during OTWE.…”