Outcome of all Tunneled Catheters for Dialysis Access: a Single Center Study

Abstract

Renal failure affects up to 18% of hospitalized patients and is associated with significant morbidity, mortality, and resource utilization. Hemodialysis is used mostly as renal replacement therapy method all over the world. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Objective: The objective of this study was to determine the outcome of all tunneled catheters placed in a single center for dialysis access over a period of six months. Study Design: Descriptive case series study Setting: Study was conducted in Dialysis Department, Combined Military Hospital, Lahore. Duration of Study: Present research was conducted from 6th May 2019 to 5th Nov 2019. Methodlogy: A total of 145 patients were enrolled after informed consent. Demographic information with duration of hemodialysis was also noted. In all patients tunneled catheter was placed for dialysis, by primary investigator. Then patients were followed-up for 2 months and were assessed for catheter in next visit. If there was redness, pain, and pus present then infection labeled. On assessment of catheter condition, if it was found damaged, fell out, exposed cuff, or fractures, blocked then catheter failure was noted. All this information was recorded through proforma. Results: Mean age was 45.72 ± 15.31 years; Mean duration of dialysis was 7.66 ± 2.93 months. Male were 53.8% and female were 46.2%. Placement of catheter was at internal jugular 116 (80%) patients, at subclavian 21 (14.5%) and at femoral 8 (5.5%). Infection was present in 13.1% patients while it was absent in 86.9% patients. Catheter failure was seen in 4.1% patients, there was no significant association between presence of catheter failure and age group, gender, BMI, duration of dialysis and site of catheter having p-value = 0.322, 0.849, 0.741, 0.716 and 0.457 respectively. Significant association was not found between presence of infection and age group, gender, BMI, duration of dialysis and site of catheter having p-value = 0.591, 0.380, 0.081, 0.538 and 0.540 respectively. Conclusion: Presence of Infection was observed in 13.1% patients and catheter failure was present in 4.1% patients with chronic kidney disease on maintenance hemodialysis. Effect modifiers like age group, gender, BMI, duration of dialysis and site of catheter did not show significant association. Keywords: Chronic Kidney Disease, Infection, Catheter Failure, Hemodialysis.