The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees.
BACKGROUND
Some nephrologists remove tunneled hemodialysis catheters (TDC) at the bedside, but this practice has never been formally studied. Our hypothesis was that bedside removal of TDC is a safe and effective procedure affording prompt removal, including in cases of suspected infection.


METHODS
We reviewed our consecutive 3-year experience (2007-2009) with bedside TDC removal at the University of Mississippi Renal Fellowship Program. Data were collected on multiple patients and procedure-related variables, success and complication rates. Association between clinical characteristics and biomarkers of inflammation and myocardial damage was examined using correlation coefficients.


RESULTS
Of 55 inpatient TDC removals (90.9% from internal jugular location), 50 (90.9%) were completed without hands-on assistance from faculty. Indications at the time of removal included bacteremia, fever or clinical sepsis with hemodynamic instability or respiratory failure. All procedures were successful, with no cuff retention noted; one patient experienced prolonged bleeding which was controlled with local pressure. Peak C-reactive protein (available in 63.6% of cohort) was 12.9 ± 8.4 mg/dL (reference range: <0.49) and median troponin-I (34% available) was 0.534 ng/mL (IQR 0.03-0.9) (reference range: <0.034) and they did not correlate with each other. Abnormal troponin-I was associated with proven bacteremia (p < 0.05) but not with systolic and diastolic BP or clinical sepsis.


CONCLUSIONS
Our results suggest that bedside removal of TDC remains a safe and effective procedure regardless of site or indications. Accordingly, TDC removal should be an integral part of competent Nephrology training.
Department of Medicine, University of Mississippi Medical Center , Jackson, MS , United States .
Tibor
T
Fülöp
Mihály
M
Tapolyai
Naseem A
NA
Qureshi
Vikram R
VR
Beemidi
Kamel A
KA
Gharaibeh
S Mehrdad
SM
Hamrahian
Tibor
T
Szarvas
Csaba P
CP
Kovesdy
Eva
E
Csongrádi
D000328:Adult; D000368:Aged; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000193:education / Q000592:standards; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D062666:Vascular Access Devices