Introduction:
Tunneled Catheters are the immediate vascular access for the initiation of haemodialysis for patients with end stage kidney disease. Common complication of tunneled dialysis catheters is fibrin sheath formation which is a protein aggregate forming a film overtime, encasing the outer wall and tip of the catheter. This rapid accumulation of protein aggregate leads to activation of the coagulation cascade. This leads to thrombotic occlusion and impairs the function of tunneled catheters. To restore the patency of catheter, the patient may undergo one among the following: thrombolysis, new catheter insertion or fibrin sheath stripping.
Methods:
This retrospective study was conducted in a tertiary care center in South India, which included all the patients on maintenance hemodialysis through tunneled catheters with fibrin sheath formation from 2010-2024. Data was collected from the institutional clinical workstation and patient records. This study was approved by the Institutional Review Board. SPSS Version 21 was used for analysis.
Results:
A total of 4143 patients underwent tunneled dialysis catheter insertions between 2010 and 2024. 43 patients underwent fibrin sheath stripping. The median duration between catheter placement and fibrin sheath formation was 70.3 (IQR 30-90) days. 53.4% were male, with a mean age of 58.3 years. 25 (58.1%) patients were diabetic and Diabetic nephropathy was the common native kidney disease. 25(58.1%) had a right jugular catheter placement, left jugular in 14 (32.6%) patients, right femoral in 2 (4.7%) patients and left femoral in 2 (4.7%) patients. 27(62.7%) had fibrin sheath formation along the catheter and the tip,13(30.2%) at the tip and 3(6.9%) along the catheter only. Most fibrin sheath formations were treated with stripping alone with 4 (9.2%) requiring concomitant tunneled catheter exchange among which 2(4.6%) patients also required balloon dilatation. Immediately after the procedure, all patients had good catheter function. Sixteen patients (37.2%) had history of multiple access failure and prior presence of history of cannulation was present in 23 (53.5%) patients. Prior history of CRBSI was present in 19(44.2%) patients. The functional patency following the procedure was 72.2% and 67.6% at 1 and 3 months respectively. At 1 month, 10 (23.2%) patients experienced repeat fibrin sheath formation among which 7 (16.3%) had new tunneled catheter placement and 3 required restriping. Among the 3 patients who underwent restriping, 2 patients required tunneled catheter exchange in same setting due to failed striping and one required balloon angioplasty. At three months, 2(4.7%) patients had recurrent fibrin sheath formation and underwent restriping.
Conclusions:
Fibrin sheath formation is a significant complication associated with tunneled dialysis catheters. This retrospective analysis showed that it does not always necessitate catheter exchange or repositioning, as fibrin sheath stripping can effectively maintain catheter patency
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.