Tunneled central venous catheters: Experience from a single center

Abstract

In the past vascular surgeons were called in to place tunneled central venous catheter (TVC) for hemodialysis patients. Advent of percutaneous technique has resulted in an increasing number of interventional nephrologists inserting it. A single centre three year audit of 100 TVCs with a cumulative follow up of 492 patient months is presented here. From 2007 to 2010, 100 TVCs were placed by nephrologists in a percutaneous fashion in the operative room or the interventional nephrology suite. Those who completed minimum of three months on the catheter were included in analysis. There were 69 males and 31 females with a mean age of 52.3±13.6 years.(range: 25-76). Chronic glomerulonephritis was the commonest cause of CKD (45%) followed by diabetes (39%).Right internal jugular vein was the preferred site (94%). TVC was utilized as the primary access to initiate dialysis in 25% of patients in whom a live donor was available for renal transplant. The blood flow was 250-270 ml/min. The Kaplan-Meier analysis showed that 3 months and 6 months catheter survival rates were 80% and 55%, respectively. The main complications were exit site blood ooze, catheter block and kink. Catheter related bacteremia rate was low at 0.4/1000 patient days. Primary cause of drop out was patient death unrelated to the TVCs. Those under the age of 40 years showed better survival, but there was no bearing of gender, catheter site, and etiology of CKD on survival. Tunneled central venous catheters could find a niche as the primary access of choice for pretransplant live donor renal transplants in view of its immediate usage, high blood flows, low infection rates and adequate patency rates for 3-6 months.

Self‐Centering, Split‐Tip Catheter has Better Patency than Symmetric‐Tip Tunneled Hemodialysis Catheter: Single‐Center Retrospective Analysis

“…In our study, patency of the symmetric‐tip catheter was similar to that of other single‐body catheters. In a retrospective study of 100 patients with TCVCs, the overall rate of dual lumen catheter patency at 3 and 6 months was estimated to be 80% and 55%, respectively .…”

Emergence of Interventional Nephrology in the Asia-Pacific Region – A Report from New Zealand

“…The benefits of using ultrasound guided central venous catheters in femoral vein was recently reported in a series of 110 patients achieving a success rate of 98.2% with a significantly lower complication rate of 5.5% compared to 18.2% with blind technique [18]. Similar experience with successful placement of 100 tunneled catheters was reported from a single center in Southern India over a 3-year period [19]. The role of interventional nephrologist in placing peritoneal dialysis catheter using Seldinger's technique was also evaluated by the same center highlighting the reduced hospital stay and early initiation of dialysis compared to the common practiced open surgical technique [20].…”

Survival of tunneled hemodialysis catheters after percutaneous placement.

“…Previous studies usually reported similar (Mandolfo et al, 2014) or less favorable catheter survival (Sampathkumar et al, 2011;Little et al, 2001;Ewing et al, 2002;Shingarev et al, 2013). In one of the largest studies reporting outcome of 573 catheters, only 47% of THCs had survived for 1 year.…”

“…In such patients, tunneled catheter serves as a "bridge" to a more permanent dialysis access. Importantly, in some countries, fistula creation may be a subject to logistic or financial limitations, which may jeopardize access to vascular surgery (Sampathkumar et al, 2011).…”