title: Externalization of tunneled hemodialysis catheter in patients with tunnel or exit-site infections and limited access options.
abstract: OBJECTIVE
  To evaluate the viability and effectiveness of temporary externalization of a tunneled hemodialysis (HD) catheter in catheter-dependent HD patients presenting with catheter-related tunnel or exit-site infection, documented central venous stenosis, and limited alternative venous access.
  
  
  METHODS
  All catheter-dependent HD patients with known central venous stenosis presenting with exit-site or tunnel infection and who subsequently underwent catheter externalization between February 2008 and May 2012 were reviewed. After catheter externalization, patients were concurrently treated with antibiotics for approximately 3 weeks before reinsertion of a new tunneled catheter. Treatment outcomes were collected, with treatment failures defined as reinfection with the same organism within 45 days of tunneled catheter reinsertion.
  
  
  RESULTS
  There were 42 catheter externalization procedures performed in 26 patients for 42 exit-site or tunnel infections. Technical success rate for catheter externalization was 100%, with no complications during the externalization procedure and preservation of all original access sites. Treatment failure occurred in 9.8% (4 of 41) of cases. Median infection-free survival after treatment and retunneling of a new dialysis catheter was 80 days. One major periprocedural complication of death occurred before reinsertion of a new tunneled catheter. Minor complications after the procedure occurred in four patients and included three cases of a small persistent wound at the temporary supraclavicular access site and one initially nonfunctioning externalized catheter.
  
  
  CONCLUSIONS
  Temporary dialysis catheter externalization appears both technically feasible and effective for the treatment of exit-site and tunnel infections, while allowing preservation of the venous access site in catheter-dependent HD patients with central venous stenosis and limited alternative venous access.
authors.affiliation: Faculty of Medicine (A.J., A.H., S.S.T., R.E.T., S.E.R.), University of Ottawa, Ottawa, Ontario, Canada; Departments of Radiology (A.J., A.H., S.S.T., R.E.T., S.E.R.).
authors.forename: Arash
authors.initials: A
authors.lastname: Jaberi
authors.affiliation: Faculty of Medicine (A.J., A.H., S.S.T., R.E.T., S.E.R.), University of Ottawa, Ottawa, Ontario, Canada; Departments of Radiology (A.J., A.H., S.S.T., R.E.T., S.E.R.). Electronic address: ahadziomerovic@toh.on.ca.
authors.forename: Adnan
authors.initials: A
authors.lastname: Hadziomerovic
authors.affiliation: Faculty of Medicine (A.J., A.H., S.S.T., R.E.T., S.E.R.), University of Ottawa, Ottawa, Ontario, Canada; Departments of Radiology (A.J., A.H., S.S.T., R.E.T., S.E.R.).
authors.forename: Sundeep S
authors.initials: SS
authors.lastname: Toor
authors.affiliation: Department of Radiology (R.P.G.), Dr. Everett Chalmers Hospital, Fredericton, New Brunswick, Canada.
authors.forename: Ramprakash P
authors.initials: RP
authors.lastname: Galwa
authors.affiliation: Nephrology (J.G.), The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Graham
authors.affiliation: Faculty of Medicine (A.J., A.H., S.S.T., R.E.T., S.E.R.), University of Ottawa, Ottawa, Ontario, Canada; Departments of Radiology (A.J., A.H., S.S.T., R.E.T., S.E.R.); Neurosciences & Clinical Epidemiology Program/Methods Centre (R.E.T.), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Thornhill
authors.affiliation: Faculty of Medicine (A.J., A.H., S.S.T., R.E.T., S.E.R.), University of Ottawa, Ottawa, Ontario, Canada; Departments of Radiology (A.J., A.H., S.S.T., R.E.T., S.E.R.).
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D061807:Catheter Obstruction; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents