Conversion of non-tunneled to tunneled hemodialysis catheters.
OBJECTIVE
To determine the safety and efficacy of conversion of non-tunneled (temporary) catheters to tunneled catheters in hemodialysis patients.


METHODS
A retrospective review of 112 consecutive conversions in 111 patients was performed over a period of 4 years. Fourteen patients were lost to follow-up. The remaining 97 patients had clinical follow-up. Temporary catheters were converted to tunneled catheters utilizing the same internal jugular venotomy sites and a modified over-the-wire technique with use of a peel-away sheath . Follow-up clinical data were reviewed.


RESULTS
Technical success was achieved in all 112 procedures. None of the 97 patients with follow-up suffered early infection within 30 days. The total number of follow-up catheter days was 13,659 (range 2-790). Cases of confirmed and suspected bacteremia requiring catheter removal occurred at a frequency of 0.10 per 100 catheter days. Suspected catheter infection treated with antibiotics but not requiring catheter intervention occurred at a frequency of 0.04 per 100 catheter days. Frequency of all suspected or confirmed infections was 0.14 per 100 catheter days. Catheter interventions as a result of poor blood flow, inadvertent removal, catheter fracture, or kinking occurred at a rate of 0.18 per 100 catheter days. Life table analysis revealed primary patency rates of 86%, 64%, and 39% at 30 days, 90 days, and 180 days, respectively.


CONCLUSIONS
Conversion of temporary catheters to tunneled catheters using the pre-existing venotomy sites is safe and has low rates of infection and malfunction. These rates are comparable to previously published rates for tunneled catheters placed de novo and tunneled catheter exchanges.
Van Ha
Thuong G
TG
Department of Radiology, Section of Interventional Radiology, The University of Chicago, 5841 S. Maryland Avenue MC2026, Chicago, IL 60637, USA. tgvanha@radiology.bsd.uchicago.edu
Fimmen
Derek
D
Han
Laura
L
Funaki
Brian S
BS
Santeler
Scott
S
Lorenz
Jonathan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D020878:Device Removal; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology; D006435:Renal Dialysis / Q000295:instrumentation*; D012107:Research Design; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014654:Vascular Patency
D000900:Anti-Bacterial Agents