Outcomes of tunneled cuffed hemodialysis catheters: An experience from a tertiary care center in Karachi, Pakistan

Abstract

Introduction: Tunneled cuffed catheters (TCC) are generally used as a temporary means to provide hemodialysis (HD) until permanent arteriovenous access is established. However, certain complications are associated with use of TCCs such as infections, catheter malfunction/malposition or venous stenosis. Limited data is available on outcomes and long term complications associated with TCCs in our country. The aim of this study was to study the outcomes of TCCs and associated long term complications during the course of its usage. Methods: We retrospectively studied case records of patients who had TCCs placed for HD at our institution, from January 2016 to June 2018. Results: A total of 116 TCCs were placed during the study period. The mean age of the population was 57.09 years; 58.6% were males. The right internal jugular vein (52.6%) was the most common site of TCC insertion followed by the left internal jugular vein (29.3%). Functioning TCCs were successfully removed in almost two-thirds of cases (65.7%) once their permanent access was mature. Development of catheter related blood stream infection (CRBSI) was seen in 22 patients (19.8%) requiring catheter removal in 14 (12.6%) patients. Mechanical complications leading to catheter removal were seen in seven patients (6.3%). The median catheter duration was 62.5 days ranging from 1 to 343 days. Conclusion: TCCs, though associated with complications particularly CRBSI, are a viable option for short- to intermediate-term use for HD till the maturation of permanent arteriovenous access in a limited-resource setting.

Tunneled dialysis catheter utilization and patency: a retrospective-prospective study from a tertiary care hospital in Karachi Pakistan

“…The median catheter stay was reported to be 62.5 (IQR: 46-89.5) days in a study from Pakistan. 15 A median catheter usage of 213 days was observed by Sampathkumar et al 16 Yalvac et al report a catheter use mean duration of 729.65 days. 17 A study in Egypt found that the average catheter lasted 122 days.…”

“…Another similar investigation from Pakistan found that during the observation period, 19.8% patients experienced CRBSIs, and 63.6% of these patients required catheter removal. 15 During one-year follow-up, bacteraemia risk was reported to be 9% at one year and any central venous catheter (CVC)related complication risk to be 30%. 19 In contrast to current findings, an upsetting infection rate was reported by an Indian study, showing that during a six-month follow-up period following the installation of the TDC, 30.4% patients had positive blood cultures.…”

Outcomes of Tunneled Dialysis Catheter In Hemodialysis Patients In A Tertiary Care Hospital

“…In our study, during one year period total 8.5% developed CRBSI which yielded an incidence rate of 5.01 per 10,000 catheter days. Another Pakistani study reported that 19.8% of patients developed CRBSI during the study period and catheter removal was required in 63.6% of these patients [20]. A risk of 9% at one year was reported for bacteremia and 30% for any CVC related complication during rst year follow-up [27].…”

“…The mean duration of catheter use greatly varies among studies. Another Pakistani study reports a median catheter duration of 62.5 (IQR=46 -89.5) days [20]. Sampathkumar et al reported a median catheter usage of 213 days [19].…”

“…In 5-18% of patients, there is anatomical variations of jugular veins, hence ultrasound guided puncture and uoroscopic guided insertion results in considerably reduced unsuccessful attempts, hematoma formation and arterial puncture [17]. During the study period, most of the patients received catheters in RIJV (87.7%) which is an established practice worldwide [18][19][20].…”