Introduction:
Effective vascular access is a cornerstone of successful hemodialysis treatment, and tunneled cuffed catheters (TCCs) offer a crucial solution when permanent access options are not viable. This study is aimed to evaluate the outcomes of non-fluoroscopic guided TCCs for hemodialysis access in a tertiary care setting.
Methods:
It was a retrospective study done in a tertiary care hospital. Adult patients with CKD (chronic kidney disease), who underwent non-fluoroscopic guided TCC insertion over period of 2 years data were extracted from medical records using a standardized data collection form and results were analyzed.
Results:
We analyzed 150 patients, with majority (44%) were aged between 41-60 years, 40%aged ≤40 years, with a predominance of males (72.7%). High comorbidity was noted (59.3%), with diabetes (32.7%) and hypertension (27.3%) being common. Chronic Interstitial Nephritis (46.7%) and Diabetic Kidney Disease (30.7%) were prevalent.
TCCs were primarily used as bridge to arteriovenous fistula (AVF) creation (62%) and as permanent access (26%). The Right Internal Jugular Vein (IJV) was the insertion site in 92% of cases. The average catheter use duration was 7.19 months. Catheters were removed in 63.3% of cases, with 36.7% lost to follow-up, predominantly due to deaths unrelated to the catheter (33.3%). Catheter-related issues accounted for only 3.3% of follow-up losses.
Key reasons for catheter removal included AVF maturation (41.3%), kidney transplantation (11.3%), and catheter-related issues (10.7%). Notably, patients with coronary artery disease (CAD), multiple access failures, catheters used for over 6 months, and femoral insertion sites experienced higher catheter-related issues (p < 0.001). Immediate complications were low (2.7%), but catheter-related bloodstream infections (CRBSI) occurred in 25.3% of cases, mainly affecting those aged 41-60 years with high comorbidity rates (76.3%).
Most patients (82.7%) with TCCs did not require further intervention, though 17.3% faced issues, with occlusion being most common. Interventions, mainly streptokinase (STK), had a 44% success rate, suggesting effectiveness but indicating room for improvement, especially in those with CAD and diabetes.
Conclusions:
Our study confirms that non-fluoroscopic guidance, primarily using ultrasound, achieves high success rates and similar catheter survival and mortality rates compared to historical data on fluoroscopic guidance methods. Thus, non-fluoroscopic guidance is an effective, safe method for TCC placement, offering the significant advantage of avoiding radiation exposure, minimizing procedural time and cost.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.