Abstract:

Introduction: COVID-19, the syndrome caused by the novel SARS-CoV2, is associated with high rates of acute kidney injury requiring renal replacement therapy (RRT). It is well known that despite the ease of bedside insertion, the use of non-tunneled dialysis catheters (NTDCs) is associated with increased complications compared to tunneled dialysis catheters (TDCs). Our objective was to develop a strategy for TDC placement at the bedside to provide effective dialysis access, conserve resources and decrease personnel exposure at our medical center in an epicenter of the COVID-19 pandemic.

Methods: A technique for bedside TDC insertion with ultrasound and plain radiographs in the intensive care unit was developed. Test- or clinically- COVID-19-positive patients requiring RRT were evaluated for bedside emergent NTDC or non-emergent TDC placement. Patients who underwent NTDC placement were monitored for ongoing RRT needs and were converted to TDC at the bedside after 3-5 days. We prospectively collected patient data focusing on complications and mortality.

Results: Of the 36 consultations for dialysis access in COVID-positive patients from March 19 through June 5, 2020, a total of 24 bedside TDCs were placed. Only one patient developed a complication, which was pneumothorax and cardiac tamponade during line placement. In-hospital mortality in the cohort was 63.9%.

Conclusions: Bedside TDC placement has served to conserve resources, prevent complications with transport to and from the operating room, and decrease personnel exposure during the COVID-19 pandemic. This strategy warrants further consideration and could be used in critically ill patients regardless of COVID status.

Reference:

Williams AD, Qaqish M, Elnagar J, Michos L, Nantermet S, Meisner R, DiGiovanni V, Uribe A. Bedside Tunneled Hemodialysis Catheter Placement in Patients with COVID-19. Ann Vasc Surg. 2021 Jan 22:S0890-5096(21)00059-5. doi: 10.1016/j.avsg.2021.01.059. Epub ahead of print. PMID: 33493592; PMCID: PMC7825820.