title: Tunneled Hemodialysis Catheter Removals by Non-Interventional Nephrologists: The University of Mississippi Experience.
abstract: Bedside removal of tunneled hemodialysis catheters (TDC) by noninterventional Nephrologists has not been frequently performed or studied. We performed a retrospective review of bedside TDC removal at the University of Mississippi Medical Center between January, 2010 and June, 2013. We collected data on multiple patients and procedure-related variables, success, and complications rates. Of the 138 subjects, mean age was 50 (±15.9) years, 49.3% were female, 88.2% African American and 41% diabetics. Site of removal was the right internal jugular (IJ) in 76.8%, the left IJ in 15.2%, and the femoral vein in 8% of patients. Exactly 44.9% of removals took place in the outpatient setting. Main indications for the removal were proven bacteremia in 30.4%, sepsis or clinical concerns for infection in 15.2% of the cases, while TDC was no longer necessary in 52.2% of patients. All removals were technically successful and well tolerated, but we observed Dacron "cuff" separation and subcutaneous retention in 6.5% of the cases. There was a significant association between outpatient removal and cuff retention (p = 0.007), but not with the site of removal or operator experience. In this relatively large mixed cohort of inpatients and outpatients, bedside TDC removal was well tolerated with a minimal complication rate.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, Hungary.
authors.forename: Tibor
authors.initials: T
authors.lastname: Fülöp
authors.affiliation: Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, Hungary.
authors.forename: Betzaida
authors.initials: B
authors.lastname: Rodríguez
authors.affiliation: Danville VAMC, Danville, Illinois, Hungary.
authors.forename: Béla A
authors.initials: BA
authors.lastname: Kosztaczky
authors.affiliation: Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, Hungary.
authors.forename: Kamel A
authors.initials: KA
authors.lastname: Gharaibeh
authors.affiliation: Department of Mathematics, Louisiana State University Shreveport, Shreveport, Louisiana, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Lengvárszky
authors.affiliation: Department of Internal Medicine, School of Medicine, Louisiana State University Health Shreveport, Shreveport, Louisiana, Hungary.|Overton Brooks Veterans' Administration Medical Center, Shreveport, Louisiana, Hungary.
authors.forename: Neville R
authors.initials: NR
authors.lastname: Dossabhoy
authors.affiliation: Fresenius Medical Care, Semmelweis University, Budapest, Hungary, Hungary.
authors.forename: Mihály B
authors.initials: MB
authors.lastname: Tapolyai
mesh_terms: D000046:Academic Medical Centers; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D019095:Point-of-Care Systems; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D016896:Treatment Outcome