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Vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis, but it is not always possible or practical in certain clinical situations such as in AVF failure or lack of suitable vessels for AVF creation or waiting for living donor transplant.Aim and objectives of the study was to study the clinical characteristics of the patients with tunneled cuffed catheters (TCC), indications for TCC, complications and to determine the infection and survival rate of catheter and patient with various factors influencing the outcome.
A retrospective observational study was done in a tertiary care centre.Twenty-seven TCC placement was done by nephrologists with fluoroscopy in a percutaneous fashion between June 2022 to July 2023. Minimum follow up period was 9 months. Patient demographics, laboratory data including microbiological profile, infection rate were collected and analyzed. Catheter dysfunction is defined as failure to attain and maintain an extracorporeal blood flow of 300ml/min or greater at a prepump arterial pressure more negative than -250mmhg. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software for Windows, version 20.0 (IBM Corp., Armonk NY).Univariate and binary logistic regression was used to determine the risk factors .Statistical analysis using Kaplan- Meier analysis was used for survival determination. All patients included in the study consented for the procedure.
Results: Among 27 patients with TCC, 22(81.48%) were males and mean age was 54.76 years. Diabetes mellitus was present in 40.7%,hypertension in 44.4% of patients,CAD in 18.5%. Most common site of TCC was right internal jugular (74%, n=20), followed by left internal jugular (14.81%, n=4), femoral TCC was done in (11%,n=3). Indication for TCC placement was starting of HD after one or two temporary access with immature veins- 19 (70.3%), followed by multiple AVF failure - 6 (22%) and awaiting living-related transplantation 2(7.4%). Catheter related infection rate (CRBSI) was 11(40.7%), exit site infection was seen in 11 cases (40.7%). Catheter dysfunction was noted in 5 patients (18.5%). Catheter loss due to CRBSI occurred in 3 patients (11%). Most common organism was Kleibsiella (18.5%), followed by E.Coli (14.81%). Among 40.7% TCC with infection,22.2% were in diabetic patients The overall incidence of TCC infections was 3.6 episodes / 1,000 catheter-days (DM vs. non-DM: 3.9 vs. 3.5 ep /1000 cath.days). There was no statistically significant difference in the incidence of TCC infections in diabetics and non-diabetics (x² = 0.34; p = 0.353). The presence of DM increases the risk of infection by 1.25 times (OR 1.25; CI 0.53 to 2.90, p = 0.606). Mean catheter survival was 193.9 +114.9 days (3day to 9 months). Catheter survival at the end of 3 months was 96.3%, at 6 months 88.8%, at 9 months 81.5%. Mortality rate was 3(14.81%) with cardiovascular cause 2(11.1%). Direct TCC infection related death occurred in one patient. Patient survival at 6 months was 92.6%, at 9 months- 88.8%.In univariate analysis of CRBSI risk factors, there was no significant association with age, diabetes, days TCHD in situ, and hypertension. In multivariate analysis, diabetes (OR, 2.2; 95% CI, 1.02–4.75) and TCHD inserted into the left internal jugular vein (OR, 4.4; 95% CI, 1.65–11.72) were independently associated with increased risk of CRBSI.
Catheter related infection rate (CRBSI) was 40.7% with majority of them occurred after 6 months of insertion, Predominant organism isolated was Klebsiella and E.Coli.Catheter dysfunction was noted in 5 patients (18.5%). Catheter survival at 6 months was 88.8% and mortality directly related to TCC due to infection occurred in 1 patient.