title: Replacement of inadvertently discontinued tunneled jugular high-flow central catheters with tract recannulation: technical results and outcome.
abstract: OBJECTIVE
  To determine the technical and clinical outcomes of recannulating the tracts of inadvertently discontinued high-flow tunneled internal jugular central venous catheters.
  
  
  METHODS
  Retrospective review was performed of 49 patients who underwent 57 replacements of inadvertently discontinued catheters by recannulation from January 1997 through January 2005. The study group was divided into successful and failed recannulation groups. Technical results were evaluated for duration the catheter had been out, tract age, and laterality (ie, right vs left). Infection rate was calculated by Kaplan-Meier method and the infection rate per 100 catheter days was calculated. Intent-to-treat function rate (including failed recannulations) was calculated by the Kaplan-Meier method.
  
  
  RESULTS
  Seventy percent (n = 40) of discontinued catheters were right-sided and 30% (n = 17) were left-sided. The overall technical success rate was 86% (n = 49). The technical success rates were 100% (n = 10), 89% (32 of 36), and 64% (seven of 11) for catheters that had been outside the body for less than 12 hours, 12-24 hours, and more than 24 hours, respectively. P values for successful versus failed recannulations for tract age, the time the catheter was out, and laterality were .02, .04, and .68, respectively. The infection rate for successful recannulations at 6 months was 24% +/- 9% (0.22 infections per 100 catheter days). Functional catheter rates at 3, 6, 9, and 12 months were 55% +/- 8%, 46% +/- 8%, 29% +/- 10%, and 5% +/- 3%, respectively.
  
  
  CONCLUSIONS
  Recannulating tunneled high-flow jugular catheter tracts has a high technical success rate, particularly when they have fallen out less than 24 hours earlier and have a mature tract. The outcomes of recannulated catheters (ie, infection and function rates) are within the upper limit of results of de novo placement and over-the-wire exchange of catheters in the literature.
authors.affiliation: Department of Radiology, Division of Vascular and Interventional Radiology, University of Rochester Medical Center, Rochester, New York, USA. saadn@mir.wustl.edu
authors.forename: Nael E A
authors.initials: NE
authors.lastname: Saad
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: David L
authors.initials: DL
authors.lastname: Waldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016009:Chi-Square Distribution; D020878:Device Removal; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014654:Vascular Patency