Dialysis Vascular Access: Where do Tunneled Catheters Stand? - A Single-Center Experience

Introduction

Tunneled cuffed catheters (TCC) provides a short and intermediate-term access solution for dialysis patients who fail to get an arteriovenous fistula (AVF). They are associated with high morbidity and mortality along with high rates of infectious complications.

Methods

We present a single-center prospective cohort of 159 TCCs inserted over one year. Patients were dialyzed in-hospital and in various peripheral dialysis units attached to the institute. The primary endpoint was catheter drop-out.

Results

The mean age of patients was 41.8 ± 16.9 years. The right internal jugular vein was the commonest site of TCC insertion (66%). The absence of suitable veins was the predominant reason for TCC insertion. The mean time to catheter drop-out was 134.4 ± 83.3 days (5-399 days). Death with a working catheter was the most common cause of catheter drop-out (22.6%). About 25% of catheters were lost to catheter-related bloodstream infections (CRBSI), either alone or as overlap with poor flow. CRBSI rates were 3.74 episodes per 1000 catheter-days. No difference in survival between the staggered tip and split-tip catheters was found.

Conclusions

With the advent of the "hub and spoke" model for dialysis in the public sector healthcare, TCCs are suboptimal with regards to patient and catheter survival, with high infection rates. It must be regarded as a temporary solution and AVF creation should be prioritized.

A rare complication of a hemodialysis tunneled catheter: Case report of a superior vena cava and right atrium candida endocarditis

Infections remain an important cause of death among hemodialysis patients. This population have a higher risk of candidemia. Candida endocarditis it´s a rare but frequently fatal complication of candidemia. A 64 year-old female presented with a purulent discharge at the insertion site of a hemodialysis tunneled cuff catheter. A catheter related bloodstream infection was suspected, cultures were obtained and wide-spectrum antibiotic therapy was administered. A multi sensitive Candida albicans was isolated. Transesophageal echocardiography showed a large vegetation located in the superior vena cava, in probable relation with a previous catheter. The first approach was antifungal treatment. Due to non-response, she did a surgical removal of the vegetation. Culture of the vegetation showed the same as the blood cultures. After one year she has no signs of relapse. To improve the prognosis of this high mortality condition a high index of suspicion is necessary for early diagnosis and timely intervention.