Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis

Abstract

Despite all efforts, still many end-stage kidney disease (ESKD) patients are dialysed using a central tunnelled catheter (CTC) as vascular access. When the CTC blood flow becomes ineffective, a number of protocols are advised. However, all of them are time-and cost-consuming. The manoeuvre of a noninvasive tunnelled catheter reposition (NTCR) was introduced to restore the CTC function. NTCR was based on gentle movements of the CTC, with or without a simultaneous flushing of the CTC lines, which resulted in a quick reposition of the CTC tip. This study comprises the analysis of a total of 297 NTCRs, which were performed in 114 patients, thus enabling an effective blood flow after 133 procedures (44.7%).Partially effective blood flow followed 123 procedures (41.4%), and it failed altogether in 41 cases (13.9%). Overall, 86% of conducted NTCRs improved the CTC patency to perform a haemodialysis session. The procedure could be successfully repeated, with a similar result after the first and the second attempt. Complications were observed only after 3.4% of all interventions. The novel NTCR manoeuvre was safe and effective in the majority of the CTC dysfunction episodes. It seemed to reduce fibrinolytic usage, allowed an immediate haemodialysis session commencement, therefore, it might save both the costs and the nursing staff time. According to registries data, CTCs were used in 68% of the incident and 32% of the prevalent haemodialysis patients in Europe 1. The 2018 Annual Data Report of the United States Renal Data System (USRDS) showed that over 80% of the US patients started haemodialysis with a CTC, and in 69% of them the catheter was still in use after 90 days 2. After comparing dialysis patients from 20 countries, catheter usage ranged from 1% in Japan to 45% in Canada 3. CTC dysfunction was a leading non-infectious complication of this type of vascular access for haemodialysis 4,5. The recent Canadian Observational Study reported one year and two year episodes, in which CTC dysfunction occurred in 15% and 18% of patients, respectively 6. It was generally defined as a failure to aspirate the locking solution from the CTC lines, blood flow rate (QB) through the lines of less than 300 ml/min., arterial pressure of less than 250 mmHg, high venous pressure greater than 250 mmHg, as well as the necessity for the CTC lines reversal 7-9. When this complication occurs repeatedly, it may lead to an ineffectiveness of renal replacement therapy (RRT) with low urea clearance (Kt/V < 1.2 or urea reduction ratio <65%) 7-9. A number of conservative measures and medical management protocols were established to solve the problem. Firstly, it is advised to flush the CTC lines with normal saline solution, place the patient in the Trendelenburg position, on a patient's sides or adjustment of a head position, and finally one can connect the CTC lines in a reversed way 7,8. However, repeated attempts, sometimes performed in an inappropriate way, increase the risk of complications, i.e. the CTC damage or a catheter-related infection...

Analysis of Different Vascular Accesses on Dialysis Quality and Infection Risk Factors of Hemodialysis Patients

“…Recently, with the increased incidence of chronic kidney disease, the number of patients with renal failure is gradually increasing [13]. To treat uremia caused by renal failure, hemodialysis is used more and more widely, and the advantages and disadvantages of various vascular pathways are more exposed to the vision of medical workers [5,14]. To carry out hemodialysis smoothly, it is particularly important for long-term dialysis patients to make individualized dialysis plans reasonably and establish and maintain good functional vascular accesses [15].…”

“…Cuff tunnel conduit (CTC) and native arteriovenous fistula (AVF) are two kinds of vascular accesses frequently used in clinical practice, which have their own advantages and disadvantages [5,6]. e advantage of CTC is that it is easy to operate and can be inserted into multiple catheters.…”

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem

“…All patients had a history of prior TCCs insertion, and the reasons for the in-hospital TCC replacement were as follows: catheter dysfunction ( n = 15), long-term duration and regular catheter exchange ( n = 6), symptomatic extremity and/or facial edema ( n = 5), catheter extrusion ( n = 1). TCC dysfunction was defined as an inability to maintain adequate extracorporeal blood flow without prolonging the prescribed HD treatment, inability to flush the locking solution from TCC lines, blood flow rate <300 ml/min, arterial pressure <250 mmHg, high venous pressure >250 mmHg, or the need for TCC lines reversal ( 2 , 16 , 17 ). All the lesions were confirmed through MSCTV.…”

AV Fistula—the Gold Standard for the Adequacy of Hemodialysis Treatment and Achieved Quality of life in Patients with ESRD

“…По-високата диализна доза в развитите страни до голяма степен е свързана и със стратегията им за промотиране на ранното конструиране на AVF, още преди започването на хемодиализно лечение. Това избягва много от неудобствата и усложненията на временния съдов достъп и в същото време осигурява адекватен кръвен дебит (20,31,34).…”