title: Posteriorly tunneled dialysis catheters for permanent use in cognitively impaired patients undergoing hemodialysis.
abstract: Cognitively impaired patients often pull at their dialysis catheters when the catheters are tunneled over the anterior chest. To potentially circumvent this, a technique was developed that tunnels the catheter posteriorly, over the patient's shoulder. A total of 32 posteriorly tunneled catheters were placed in 12 patients. The mean catheter use interval was 164 days, with a total of 5,248 catheter use days. Indications for nonelective catheter removals were catheter dysfunction (n = 7; 23.3%), removal by the patient (n = 7; 23.3%), infection (n = 5; 16.7%), and inadvertent dislodgment (n = 1; 3.3%). Only six of the 12 patients were able to dislodge their catheters. The procedure described here reduced catheter manipulation and extended catheter viability in these patients.
authors.affiliation: Department of Diagnostic Imaging, Mackenzie Health, 10 Trench St., Richmond Hill, ON, Canada L4C 4Z3.. Electronic address: mstroz@qmed.ca.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Stroz
authors.affiliation: Department of Nephrology, Mackenzie Health, 10 Trench St., Richmond Hill, ON, Canada L4C 4Z3.
authors.forename: Bharat
authors.initials: B
authors.lastname: Nathoo
authors.affiliation: Department of Diagnostic Imaging, Mackenzie Health, 10 Trench St., Richmond Hill, ON, Canada L4C 4Z3.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Stroz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010361:Patients / Q000523:psychology*; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome