Tunneled CVC insertion site care

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Kerr et al (2008) suggest that a purse-string suture at the CVC tunnel exit site may reduce bleeding at the insertion site.

Kerr, A., Pathalapati, R., Qiuhu, S. and Baumstein, D. (2008) Purse-string Suture to Prevent Bleeding after Tunneled Dialysis Catheter Insertion. Journal of Vascular and Interventional Radiology. 19(8), p.1176-1179.

Abstract:

Purpose: To determine whether placing a purse-string suture at the tunnel exit site at the time of tunneled dialysis catheter (TDC) insertion will decrease postprocedural bleeding.

Materials and Methods: In a retrospective single-center, single-operator study, 51 patients in the control group had TDCs inserted without purse-string sutures at the tunnel exit site and 50 patients in the experimental group had TDCs inserted with purse-string sutures at the tunnel exit site. The patients’ charts were evaluated for postprocedural progress notes describing bleeding, plasma hemoglobin levels before and after catheter insertion, and transfusion of packed red blood cells in the first 5 days after catheter insertion.

Results: Thirteen patients in the control group (25.4%) and three patients in the experimental group (6%) had postprocedural chart notes describing bleeding. The difference between the two groups was highly significant (P = .0124). Six percent of patients in the control group and none of the patients in the experimental group required prolonged compression or compression dressing placement after catheter insertion. There was a significant mean hemoglobin decrease of 0.3 g/dL after catheter insertion in the control group and an insignificant mean hemoglobin decrease of 0.1 g/dL in the experimental group. The difference in hemoglobin decrease between the two groups was not significant. The difference in the number of patients requiring transfusion in the 5 days after catheter insertion (eight of 51 vs nine of 50) was not significant.

Conclusions: Venous bleeding after TDC insertion is a complication that merits attention. Routine purse-string suture placement at the tunnel exit site is a minor change in standard technique that can nearly eliminate this problem, as reflected in postprocedural chart notes.
Kerr et al (2008) suggest that a purse-string suture at the CVC tunnel exit site may reduce bleeding at the insertion site.

Kerr, A., Pathalapati, R., Qiuhu, S. and Baumstein, D. (2008) Purse-string Suture to Prevent Bleeding after Tunneled Dialysis Catheter Insertion. Journal of Vascular and Interventional Radiology. 19(8), p.1176-1179.

Abstract:

Purpose: To determine whether placing a purse-string suture at the tunnel exit site at the time of tunneled dialysis catheter (TDC) insertion will decrease postprocedural bleeding.

Materials and Methods: In a retrospective single-center, single-operator study, 51 patients in the control group had TDCs inserted without purse-string sutures at the tunnel exit site and 50 patients in the experimental group had TDCs inserted with purse-string sutures at the tunnel exit site. The patients’ charts were evaluated for postprocedural progress notes describing bleeding, plasma hemoglobin levels before and after catheter insertion, and transfusion of packed red blood cells in the first 5 days after catheter insertion.

Results: Thirteen patients in the control group (25.4%) and three patients in the experimental group (6%) had postprocedural chart notes describing bleeding. The difference between the two groups was highly significant (P = .0124). Six percent of patients in the control group and none of the patients in the experimental group required prolonged compression or compression dressing placement after catheter insertion. There was a significant mean hemoglobin decrease of 0.3 g/dL after catheter insertion in the control group and an insignificant mean hemoglobin decrease of 0.1 g/dL in the experimental group. The difference in hemoglobin decrease between the two groups was not significant. The difference in the number of patients requiring transfusion in the 5 days after catheter insertion (eight of 51 vs nine of 50) was not significant.

Conclusions: Venous bleeding after TDC insertion is a complication that merits attention. Routine purse-string suture placement at the tunnel exit site is a minor change in standard technique that can nearly eliminate this problem, as reflected in postprocedural chart notes.

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