The Risk of Bleeding with Tunneled Dialysis Catheter Placement

Beathard, Gerald A.; Urbanes, Aris; Litchfield, Terry

doi:10.5301/jva.5000586

Cited by 6 publications

(7 citation statements)

References 21 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, patients who 8 The risk of bleeding due to TCC insertion has been reported as extremely low. 16 Although hematoma and arterial puncture were observed in nine patients, no bleeding requiring blood transfusion was encountered in our study. Incorrect insertion into the mediastinum and mediastinal hematoma was observed in one patient each.…”

Section: Discussionmentioning

confidence: 52%

“…Arterial puncture, bleeding, pneumothorax, hemothorax, air embolus, arrhythmias, and primary failure (technical error) are known as complications during catheter insertion . The risk of bleeding due to TCC insertion has been reported as extremely low . Although hematoma and arterial puncture were observed in nine patients, no bleeding requiring blood transfusion was encountered in our study.…”

Section: Discussionmentioning

confidence: 54%

See 1 more Smart Citation

Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single‐center experience

Okamoto

Sakurada

Koitabashi

et al. 2018

Hemodialysis International

View full text Add to dashboard Cite

Introduction: As the number of elderly end‐stage renal disease patients lacking suitable vessels for arteriovenous fistula (AVF) is increasing, indications for tunnel cuffed catheters (TCCs) may be expanding. This study aimed to clarify changes over time in the number of patients with TCC and indications for TCCs. Methods: This single‐center retrospective study analyzed 143 catheters for 95 patients who inserted TCCs between July 2005 and July 2017. Patients were divided into two groups (early‐ and late‐phase groups) based on the median observational period. Demographic data and clinical information were then compared. Findings: Fifty TCCs were inserted in the early phase group, and 93 TCCs were inserted in the late‐phase group. The late‐phase group was older (77 vs. 70 years; P = 0.003) and showed a higher frequency of hypertensive nephropathy (29% vs. 14%; P < 0.05) and a lower frequency of a history of cardiovascular disease (52.7% vs. 70.0%; P = 0.045). In the late‐phase group, indications for bridge vascular access (0% vs. 11.8%; P < 0.05) or severe cardiac dysfunction (8.0% vs. 20.5%; P < 0.05) were increased. In addition, the late‐phase group showed increases in percentage of patients with the catheter inserted in the femoral vein (10.0% vs. 23.7%; P = 0.047), nephrologists performing catheter insertion (56.0% vs. 87.1%; P < 0.001), and the patients who underwent superficialization of the brachial artery (28.0% vs. 46.2%; P = 0.034). Significant differences in catheter survival, incidence of complications, reasons for catheter removal, or incidence of catheter‐related infection were not observed between groups. Discussion: Patients with indications for TCC may be increasing due to an increase in elderly end‐stage renal disease patients whose activities of daily living have decreased. In addition, indications for bridge vascular access were widely accepted in the late‐phase group.

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 54%

Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single‐center experience

Okamoto

Sakurada

Koitabashi

et al. 2018

Hemodialysis International

View full text Add to dashboard Cite

show abstract

“…39 In a retrospective study on tunneled-cuffed dialysis catheters, no difference was found in terms of bleeding comparing patients on oral antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid) vs. patients treated intravenously with unfractionated heparin (UFH) vs. patients who were not receiving any antithrombotic treatment. 40 In a small population of patients on clopidogrel treatment, insertion of tunneled-cuffed dialysis catheters was not associated with any hemorrhagic complication. 41 In a retrospective analysis of ultrasound guided radiological implantation of 1200 TIVADs in patients with thrombocytopenia, the threshold of platelet transfusion was <50 × 10 9 /L; the success of insertion was 100% in all patients, and there was no difference in terms of complications between patients with normal platelet count versus patients with platelet <50 × 10 9 /L but treated with preinsertion platelet transfusion.…”

Section: Q1 -Panelmentioning

confidence: 92%

Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: A systematic review and a GAVeCeLT consensus statement

et al. 2022

View full text Add to dashboard Cite

Insertion of venous access devices (VAD) is usually considered a procedure with low risk of bleeding. Nonetheless, insertion of some devices is invasive enough to be associated with bleeding, especially in patients with previous coagulopathy or in treatment with antithrombotic drugs for cardiovascular disease. The current practices of platelet/plasma transfusion in coagulopathic patients and of temporary suspension of the antithrombotic treatment before VAD insertion are based on local policies and are often inadequately supported by evidence, since many of the clinical studies on this topic are not recent and are not of high quality. Furthermore, the protocols of antithrombotic treatment have changed during the last decade, after the introduction of new oral anticoagulant drugs. Though some guidelines address some of these issues in relation with specific procedures (port insertion, etc.), no evidence-based document covering all the aspects of this clinical problem is currently available. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to develop a consensus on the management of antithrombotic treatment and bleeding disorders in patients requiring VADs. After a systematic review of the available evidence, the panel of the consensus (which included vascular access specialists, surgeons, intensivists, anesthetists, cardiologists, vascular medicine experts, nephrologists, infective disease specialists, and thrombotic disease specialists) has structured the final recommendations as detailed answers to three sets of questions: (1) which is an appropriate classification of VAD-related procedures based on the specific bleeding risk? (2) Which is the appropriate management of the patient with bleeding disorders candidate to VAD insertion/removal? (3) Which is the appropriate management of the patient on antithrombotic treatment candidate to VAD insertion/removal? Only statements reaching a complete agreement were included in the final recommendations, and all recommendations were offered in a clear and synthetic list, so to be easily translated into clinical practice.

show abstract

“…This is particularly so when it is clear that the thrombocytopenia is due to peripheral platelet destruction (eg, ITP) and the platelets are young, large, and healthy. In a study by Beathard et al, the incidence of significant bleeding following a TDC insertion in patients who were on active anticoagulation was <0.4% and did not require any hospitalization or transfusion of blood products . If it is not possible to correct coagulopathy, a non‐tunneled catheter can often be placed first until a TDC insertion is safe for the patient.…”

Section: Potential Problems In Insertion Of Tdcmentioning

confidence: 99%

Avoiding problems in tunneled dialysis catheter placement

Agarwal

Haddad

Boubes

2019

Seminars in Dialysis

View full text Add to dashboard Cite

Tunneled dialysis catheters (TDCs) remain the predominant vascular access for initiation of hemodialysis (HD) worldwide. TDCs are also utilized in a significant number of prevalent patients for continuation of dialysis and during the periods of complications related to arteriovenous (AV) accesses. TDC placement is a routine procedure, but can be associated with mechanical and infectious complications related to placement. Imaging guidance with ultrasound and fluoroscopy has made the placement of TDC safer and more successful. Adequate operator training, careful technique, utilization of a checklist, and barrier precautions are essential to avoid problems related to TDC placement.

show abstract

The Risk of Bleeding with Tunneled Dialysis Catheter Placement

Abstract: Based upon these data, it seems reasonable to classify the TDC placement procedure as having a very low risk of bleeding and to not require preprocedure laboratory testing. The value of suspending antithrombotic medications prior to TDC placement cannot be supported.

Cited by 6 publications

References 21 publications

Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single‐center experience

Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single‐center experience

Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: A systematic review and a GAVeCeLT consensus statement

Avoiding problems in tunneled dialysis catheter placement

Contact Info

Product

Resources

About