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).