3438 OUTCOME OF HEMODIALYSIS TUNNELED CUFFED CATHETER PLACEMENT BY THE NEPHROLOGIST AT THE DIALYSIS UNIT

Abstract Background and Aims A large proportion of patients starts dialysis treatment with a temporary catheter which is afterwards replaced by a tunneled cuffed catheter (TCC) by the surgeon or interventional radiologist. This implies a certain dependency on the availability of the surgeon or radio...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2023-06, Vol.38 (Supplement_1)
Main Authors: Camp, Sander, De Clerck, Dieter, Cools, Wilfried, Van Der Niepen, Patricia
Format: Article
Language:English
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Summary:Abstract Background and Aims A large proportion of patients starts dialysis treatment with a temporary catheter which is afterwards replaced by a tunneled cuffed catheter (TCC) by the surgeon or interventional radiologist. This implies a certain dependency on the availability of the surgeon or radiologist. During this waiting time, the patient is exposed to a temporary catheter, which is accompanied by a higher risk of infection. At the UZ Brussel, until 2017 TCC's were placed at the operating room by the surgeon. In September 2017 nephrologists at the UZ Brussel started to place TCC's at the dialysis unit, without the use of fluoroscopy, to lower the time of exposure to a temporary catheter. Method We did a retrospective analysis of 100 patients who got a TCC placed at the dialysis unit from September 2017 until February 2021 (nephrologist group); as a control group we evaluated the last 100 patients who got a TCC by the surgeon before this period. We evaluated complications (during procedure and within the first month), catheter function during the second week and after three months, and waiting time to get a TCC. Logistic regression analysis was performed to detect differences in complication rate and catheter function. Two-way analysis of variance was performed on the log transformed waiting times. Results In both groups, comorbidities such as diabetes mellitus, history of cardiac surgery and presence of a pacemaker or port-a-cath at the time of catheter insertion were comparable. In both groups almost half of the patients were taking antiplatelet therapy. In the nephrologist group more patients got a catheter because of AKI (32% versus 15%) and less patients had a planned admission (19% versus 42%). More patients had a TCC placement after an ICU admission (33% versus 18%) and only few of the catheter placements were replacements of in situ TCC's (3% versus 35%). In the nephrologist group, catheters were inserted in the right (93%) and left jugular vein (7%). In the surgeon group, catheters were inserted in the right (71%) and left jugular vein (23%) and in the subclavian vein (6%). In the nephrologist group there were no failed procedures, but 2 left jugular vein catheters were not in the correct position (turning upwards in the superior vena cava). In 3 patients the carotid artery was punctured and 3 patients had a significant exit site bleeding. In the surgeon group, 3 patients had a failed procedure and 2 patients had a carotid puncture. Analysis o
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfad063c_3438