title: Replacement of failing tunneled hemodialysis catheters through pre-existing subcutaneous tunnels: a comparison of catheter function and infection rates for de novo placements and over-the-wire exchanges.
abstract: OBJECTIVE
  Tunneled hemodialysis catheter dysfunction often occurs from fibrin sheath formation. As a way to preserve existing catheter venous access sites, the authors evaluated over-the-wire exchange of catheters through pre-existing subcutaneous tunnels as an alternative to catheter removal and de novo catheter replacement.
  
  
  METHODS
  One hundred nineteen catheters were placed in 68 patients. Seventy-seven catheters were placed de novo and 42 catheters were placed through the pre-existing subcutaneous tunnels of failing catheters. Technical success, short-term complications, infection rates, and functional catheter longevity were evaluated.
  
  
  RESULTS
  Technical success for catheter exchange was 93%. Infection rates were comparable to those of de novo catheter placement: 0.15 and 0.11 infections per 100 catheter days for de novo and exchanged catheters, respectively. Catheter duration of function was not significantly different for de novo versus exchanged catheters: 63% and 51% at 3 months, 51% and 37% at 6 months, and 35% and 30% at 12 months, respectively.
  
  
  CONCLUSIONS
  Over-the-wire exchange of tunneled hemodialysis catheters is safe and easily performed. It causes no increase in infectious complications and provides similar catheter longevity to de novo catheter placement. The procedure is an important option for prolonging tunneled hemodialysis catheter access sites.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: R
authors.initials: R
authors.lastname: Duszak
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Haskal
authors.forename: C
authors.initials: C
authors.lastname: Thomas-Hawkins
authors.forename: M C
authors.initials: MC
authors.lastname: Soulen
authors.forename: R A
authors.initials: RA
authors.lastname: Baum
authors.forename: R D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: C
authors.initials: C
authors.lastname: Cope
mesh_terms: D002408:Catheters, Indwelling / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D006435:Renal Dialysis; D016019:Survival Analysis