Tunneled Hemodialysis Catheter Removals by Non-Interventional Nephrologists: The University of Mississippi Experience

Autor:	Neville R. Dossabhoy, Béla A. Kosztaczky, Kamel A. Gharaibeh, Tibor Fülöp, Mihály Tapolyai, Betzaida Rodríguez, Zsolt Lengvárszky
Rok vydání:	2015
Předmět:	Male Nephrology medicine.medical_specialty Point-of-Care Systems Hemodialysis Catheter Femoral vein Sepsis Catheters Indwelling Renal Dialysis Internal medicine medicine Humans Device Removal Retrospective Studies Academic Medical Centers business.industry Retrospective cohort study Middle Aged medicine.disease Surgery Treatment Outcome Bacteremia Cuff Cohort Kidney Failure Chronic Equipment Failure Female business Follow-Up Studies
Zdroj:	Seminars in Dialysis. 28:E48-E52
ISSN:	0894-0959
DOI:	10.1111/sdi.12364
Popis:	Bedside removal of tunneled hemodialysis catheters (TDC) by noninterventional Nephrologists has not been frequently performed or studied. We performed a retrospective review of bedside TDC removal at the University of Mississippi Medical Center between January, 2010 and June, 2013. We collected data on multiple patients and procedure-related variables, success, and complications rates. Of the 138 subjects, mean age was 50 (±15.9) years, 49.3% were female, 88.2% African American and 41% diabetics. Site of removal was the right internal jugular (IJ) in 76.8%, the left IJ in 15.2%, and the femoral vein in 8% of patients. Exactly 44.9% of removals took place in the outpatient setting. Main indications for the removal were proven bacteremia in 30.4%, sepsis or clinical concerns for infection in 15.2% of the cases, while TDC was no longer necessary in 52.2% of patients. All removals were technically successful and well tolerated, but we observed Dacron "cuff" separation and subcutaneous retention in 6.5% of the cases. There was a significant association between outpatient removal and cuff retention (p = 0.007), but not with the site of removal or operator experience. In this relatively large mixed cohort of inpatients and outpatients, bedside TDC removal was well tolerated with a minimal complication rate.
Databáze:	OpenAIRE
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