Yeungnam Univ J Med.  2020 Jul;37(3):186-193. 10.12701/yujm.2019.00465.

Improvement of catheter-related outcomes after application of tunneled cuffed hemodialysis catheter insertion without fluoroscopy

• Kang SH
• Do JY

• KMID: 2506517
• DOI: http://doi.org/10.12701/yujm.2019.00465

Abstract

Background
Non-tunneled catheters (NTCs) are used for hemodialysis (HD) in many centers in which fluoroscopy is not easily accessed despite high complication rates and conditions requiring long-term HD. Therefore, here we aimed to evaluate the superiority of catheter-related outcomes after the application of tunneled cuffed catheter (TCC) without fluoroscopy versus unconditioned NTC insertion.
Methods
We divided the participants into two phases: those receiving NTCs between March 2010 and February 2011 (phase I), and those receiving TCCs or NTCs between March 2011 and February 2012 (phase II). Catheter survival, nurse satisfaction, and reasons for catheter removal were analyzed.
Results
Two hundred and sixty patients in phase I and 300 patients in phase II were enrolled in this study. The success rate of TCC insertion was 99.2%. The catheter survival rate in phase I was 65.5% at 1 month, while that in phase II was 74.9% at 1 month (p=0.023). We compared catheter survival between TCCs and NTCs for all periods regardless of phase. The TCC survival rate was higher than the NTC survival rate (p<0.001). Catheter-associated problems led to catheter removal in 97 patients (26.6%) in phase I and 68 patients (18.5%) in phase II (p=0.009). Among 14 HD nurses, all reported being satisfied with manipulation during pre-/post-HD, manupulation during HD, and overall. Eleven HD nurses (78.6%) reported being satisfied with the workload.
Conclusion
Compared with unconditional NTC insertion for HD, TCC insertion without fluoroscopy improved the overall catheter survival and nurse satisfaction rates.

Keyword

Central venous catheter; Fluoroscopy; Hemodialysis; Renal dialysis

Figure

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  Fig. 1. Catheter survival rate. (A) Plot by application of TCC (phase I, 65.5% at 1 month and 50.7% at 5 months; phase II, 74.9% at 1 month and 63.7% at 5 months). (B) Plot according to HD catheter type (NTC [FV], 44.7% at 1 month and 25.6% at 5 months; NTC [IJV], 77.6% at 1 month and 61.7% at 5 months; TCC, 98.2% at 1 month and 94.4% at 5 months). TCC, tunneled cuffed catheter; HD, hemodialysis; NTC, non-tunneled catheter; FV, femoral vein; IJV, internal jugular vein.

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  Fig. 2. Study population and reasons of catheter removal by study period and catheter survival at 3 months after catheter insertion in (A) phase I, (B) phase II. TCC, tunneled cuffed catheter.

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  Fig. 3. Catheter survival rates at 5 months for TCC, NTC (IJV) in phase I, NTC (IJV) in phase II, NTC (FV) in phase I, and NTC (FV) in phase II were 94.4%, 62.4%, 50.0%, 31.8%, and 17.8%, respectively. p<0.001 for TCC vs. the other catheters, NTC (IJV) in phase I or II vs. NTC (FV) in phase I or II, p=0.975 between NTC (IJV) in two phases, and p=0.494 between NTC (FV) in phases I and II. TCC, tunneled cuffed catheter; NTC, non-tunneled catheter; IJV, internal jugular vein; FV, femoral vein.

Reference

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