HEMODIALYSIS CATHETER EXCHANGE WITH DOUBLE-WIRE GUIDANCE: SHOULD IT BE USED MORE WIDELY IN TUNNELED CATHETER REPLACEMENT?
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Keywords
Tunneled hemodialysis catheter, catheter exchange, same access double wire method, end-stage renal disease, catheter insufficiency, cuff extrusion
Abstract
Aim: To report the outcomes of using the same-access double wire (SA-DW) method for replacing tunneled hemodialysis catheters in cases of cuff extrusion or catheter insufficiency, through an approach which utilizes the same tunnel and venous insertion site over two guidewires.
Methods: This was a prospectively planned observational study conducted between January 2021 and July 2022. A total of 50 patients who underwent tunneled hemodialysis catheter exchange with the SA-DW method were included in the study. The outcomes of a total of 69 exchange procedures were evaluated. Each catheter exchange was considered an independent event (or, for simplicity, an independent patient). Patients' age, sex, comorbidity data, the duration of chronic renal failure, and catheter procedure-related events were recorded.
Results: Patients' ages ranged from 34 to 92 (mean: 65.18 ± 13.68 years), and 68.12% (n = 47) were female. A new catheter was inserted with the SA-DW method through the internal jugular vein in 42 (60.87%) patients, and in the femoral vein in 27 (39.13%) patients. Early (0-3 days), midterm (4-30 days), and late (>30 days) complication rates were 21.7% (n = 15), 2.9% (n = 2), and 44.9% (n = 31), respectively. Catheter-related hospitalization rate was 28.99%. Catheter exchanges were performed due to infection in 11.6%, and mortality rate due to catheter infection was 2.9%. Successful utilization of exchanged catheters was 62.3% during the follow-up period. Two patients (2.90%) died due to catheter-related infections.
Conclusion: Tunneled hemodialysis catheter exchange with the SA-DW method may facilitate easier application and better vascular protection in recurrent catheter exchanges.
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Davut Azboy
Elazığ Fethi Sekin City Hospital, orcid: 0000-0001-5174-9378
Zeki Temiztürk
Başakşehir Çam Sakura City Hospital, Orcid: 0000-0002-9357-6345