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Though the best vascular access for haemodialysis is an arteriovenous fistula, many patients do not have this made by the time they initiate maintenance haemodialysis for end- stage renal disease. Such patients require some form of temporary vascular access. Tunneled dialysis catheters have several advantages over temporary double lumen catheters and are thus preferred in such situations. The insertion procedure could be complicated by bleeding from the catheter exit site. This study was planned to document the effectiveness of a purse string suture at the catheter exit site in reducing bleeding after catheter insertion.
We conducted this randomized controlled trial from May to October 2023. Adult patients requiring tunneled catheters for maintenance haemodialysis were enrolled subject to written consent. Exclusion criteria included blood pressure ≥180/110 mmHg, current use of anticoagulants, platelets count <50000/µl, prolonged prothrombin or activated partial thromboplastin time, or previous tunneled catheter insertions at the same site. All patients had tunneled catheters placed using ultrasound guidance for venous puncture. None of the procedures utilized fluoroscopic guidance to aid ideal placement because of non- availability. Using online computer-generated random number tables, patients were randomized into two groups: one receiving a purse string suture about 1 cm proximal to catheter exit site at the end of the procedure and the other not getting it. This was removed after 24 hours. Patients were guided on applying local pressure at the exit site in case of minor ooze and report to paramedical staff if it did not stop within 5 minutes. This was then considered to be significant.
Out of 138 patients aged 62.45± 11.99 years, 98 (71.01%) were males. Majority of the catheters were placed in the right internal jugular vein (124; 89.86%), and had a size 15.5 Fr (110; 79.71%). Bleeding was seen in 5 (7.25%) out of 69 patients getting a purse string suture and 18 (26.09%) out of 69 patients without a purse string suture (p=0.003). Bleeding from catheter exit site was not related to the size of the catheter either. It was seen in 18 (16.36%) out of 110 patients getting 15.5 Fr catheter placed and 5 (17.86%) out of 28 patients with a 14.5 Fr catheter. Catheter tip readjustment after post- procedure chest X- ray was not required in any of the procedures.
Application of a purse string suture at the tunneled haemodialysis catheter exit site reduces risk of bleeding after the procedure.