title: Translumbar hemodialysis catheters in patients with limited central venous access: does patient size matter?
abstract: OBJECTIVE
  To describe a single institutional experience with translumbar tunneled dialysis catheters (TDC) and compare outcomes between patients with normal and abnormal body mass index (BMI).
  
  
  METHODS
  Translumbar TDCs placed between January 2002 and July 2011 were reviewed retrospectively. There were 33 patients; 18 had a normal BMI<25, and 15 had an abnormal BMI>25. Technical outcome, complications, indications for exchange or removal, and BMI were recorded. Catheter dwell time, catheter occlusion rate, frequency of malposition, and infection rates were collected.
  
  
  RESULTS
  There were 92 procedures (33 initial placements) with 7,825 catheter days. The technical success rate was 100%. Two minor (2.2%) and three major (3.3%) complications occurred. The complication rate did not differ significantly between patients with a normal BMI and patients with an abnormal BMI. Median catheter time in situ (interquartile range) for all patients was 61 (113) days, for patients with normal BMI was 66 (114) days, and for patients with abnormal BMI was 56 (105) days (P = .9). Primary device service intervals for all patients, patients with normal BMI, and patients with abnormal BMI were 47 (96) days, 63 (98) days, and 39 (55) days (P = .1). Secondary device service intervals for all patients, patients with normal BMI, and patients with abnormal BMI were 147 (386) days, 109 (124) days, and 409 (503) days (P = .23). Catheter-related central venous thrombosis rate was 0.01 per 100 catheter days (n = 1).
  
  
  CONCLUSIONS
  Translumbar TDC placement can provide effective hemodialysis in patients with limited venous reserve regardless of the patient's BMI. An abnormal BMI (>25) does not significantly affect complication rate, median catheter time in situ, or primary or secondary device service interval of translumbar TDCs.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Nadolski
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Cormac
authors.initials: C
authors.lastname: Farrelly
mesh_terms: D015992:Body Mass Index; D061807:Catheter Obstruction / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D020878:Device Removal; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology