Tunneled dialysis catheter exchange through fibrin sheath

"For patients with tunneled dialysis catheter dysfunction caused by fibrin sheath, catheter exchange through fibrin sheath crevice most likely is an safe and effective alternative strategy of the in-situ catheter exchange" Li et al (2020).
Abstract:

PURPOSE: To evaluate the safety and efficacy of tunneled dialysis catheter exchange through fibrin sheath crevice vs in-situ catheter exchange in hemodialysis patients with fibrin-sheath-related catheter dysfunction.

METHODS: Patients with fibrin-sheath-related catheter dysfunction underwent tunneled dialysis catheter exchange in our center between 2012 January to 2017 December were retrospectively screened. The included patients were divided into the sheath-crevice group (catheter was exchanged through fibrin sheath crevice) and the in-situ group (catheter was exchanged in-situ). The blood volume, Kt/V values, and complications were accessed as outcomes.

RESULTS: Of the 44 included patients, 25 underwent in-situ catheter exchange and 19 underwent catheter exchange through fibrin sheath crevice. The stabilized maximal blood flow during the first hemodialysis after the catheter replacement reached 250 mL/min in all of the included patients. After 3 months, the stabilized maximal blood flow of the in-situ group and the sheath-crevice group were 245.3 ± 9.0 mL/min and 244.8 ± 10.05 mL/min (P = 0.963), respectively. However, after 6 months, the stabilized maximal blood flow during hemodialysis (P = 0.048) and the Kt/V value (P < 0.001) of the patients in the sheath-crevice group were significantly higher than the in-situ group. No severe complication related to the catheter exchange surgery was observed in neither group.

CONCLUSION: For patients with tunneled dialysis catheter dysfunction caused by fibrin sheath, catheter exchange through fibrin sheath crevice most likely is an safe and effective alternative strategy of the in-situ catheter exchange.

Reference:

Li, L., Zhan, S., Zhang, L., Yang, T., Hou, X., Ren, S. and Wang, Y. (2020) Tunneled dialysis catheter exchange through fibrin sheath crevice vs in-situ catheter exchange for the treatment of catheter dysfunction. Therapeutic Apheresis and Dialysis. January 9th. doi: 10.1111/1744-9987.13473. (Epub ahead of print).

Safety IV catheter