Clinical application of non-incision removal of tunneled cuffed catheter / 中华肾脏病杂志

Objective:To explore the effectiveness and complications of non-incision removal of tunneled cuffed catheter (TCC).Methods:The clinical characteristics, surgical plans and complications of patients with TCC removal in the Renal Division of Peking University First Hospital from January 1, 2015 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into non-incision removal group and traditional incision removal group. The clinical characteristics, procedure success rate, procedural duration and complications were compared between the two groups.Results:A total of 349 patients were included in this study, for whom 368 catheter removal procedures were performed, including 286 procedures in the non-incision removal group, 75 procedures in the traditional incision removal group, and 7 procedures without records of surgical plans. There was no significant difference in age, sex, basic kidney diseases and catheter remaining time and location between the two groups (all P>0.05). Two procedures in the non-incision removal group and 1 procedure in the traditional incision removal group failed respectively, and there was no significant difference in the procedure success rate between the two groups (99.3% vs 98.7%, χ2=0.290, P=0.590). The procedural duration in the non-incision removal group was lower than that in the traditional incision removal group [(5.36±1.70) min vs (17.55±3.28) min, t=44.198, P<0.001]. Among the patients who needed TCC exchange, there was no significant difference in the selection of new catheter position between the two groups ( P=0.330). In terms of complications, there were 2 procedures of local hematoma in the non-incision removal group and 1 procedure of infection in the traditional incision removal group, and there was no severe complication in both groups. Conclusions:There was no significant difference in the procedural success rate and complications between non-incision removal group and traditional incision removal group, and non-incision procedure may be superior in reducing the procedure duration and harm less to the patients. Non-incision procedure is a safe and effective method to remove TCC.

A Case of Tunneled Cuffed Catheter Dysfunction Treated with Fibrin Sheath Stripping / 대한신장학회잡지

With the increasing proportion of elderly and diabetic dialysis patients, permanent dual lumen catheters are becoming popular. One of the most frequent causes for the failure of hemodialysis in CRF patients with the tunneled cuffed catheter is the catheter dysfunction. It is thought to be due to encasement of the catheter by fibrin sleeve or fibrin sheath, kinking or malposition of the catheter. Catheter dysfunction due to fibrin sheath formation could sometimes be managed by reversal of arterial and venous lines, urokinase lock or infusion, and catheter exchange. Recently percutaneous fibrin sheath stripping (PFSS) became another modality of salvaging failing tunneled cuffed catheter before attempting catheter exchange. There was no report of applying PFSS to salvage the permanent dual lumen catheter in Korea. Authors recently experienced a case of successful application of PFSS to extend the life of catheter in a CRF patients as a last resort after failure of repeated urokinase trials. It is thought that PFSS is a simple and effective procedure which extends the longevity of permanent dual lumen catheter.

The Use of Tunneled Cuffed Catheter(Permcath(R)) in ESRD Patients / 대한신장학회잡지

BACKGROUND: Mortality and morbidity of ESRD patients depend on a maintenance of vascular access for dialysis. Polyurethane teflon double lumen catheters have been used for a temporary vascular access for hemodialysis. But, their use has a high rate of complications and a limited duration. Recently developed tunneled cuffed catheter(Permcath(R)) have lesser complications and longer durability and it could be an alternative for double lumen polyurethan catheter. This study evaluated the usefulness and complications of a tunneled cuffed catheter as a long-term vascular access at the Korea University Medical Center. METHODS: The study was done retrospectively through medical chart review and telephone interview to investigate age, sex, the absence or presence of diabetes mellitus, catheter performance, indications for a insertion, complications, causes of catheter removal. 101 catheters were inserted in 86 ESRD patients(80 jugular, 21 subclavian) from February, 1995 to August, 1999. The complication rates and it's association with diabetes mellitus and the location of catheter insertion were reviewed. RESULTS: The mean age of patients was 58 years (49 men, 37 women). 35 patients were diabetics. The purpose of catheters insertion were : 1) waiting for the maturation of an arteriovenous fistula(46%), 2) no other available vascular access(31%), 3) after a removal or insertion of peritoneal dialysis catheters (15%), 4) waiting for the better vascular access operation(5%). Catheters were removed because of mechanical obstructions(8%), infections(12%), deaths of patients(16%). 51% of patients had catheter related complications. Local bleeding(70%) was the most common complication. Bacteremia and exit site infection rate were 30% and 14% respectively. The complication rates had no association with age, sex, the absence or presence of diabetes mellitus and the location of catheter insertion. However, a subcalvian catheter was more vulnerable to exit site infection than an internal jugular catheter. CONCLUSIONS: A tunneled cuffed catheter is safer, and more durable than a polyurethane teflon double lumen catheter. It could be used for a short-term vascular access, or for a permanent vascular access in person otherwise with no other alternatives.