Outpatient removal of tunneled dialysis catheters by nephrology fellows in training at a Veterans Affairs Medical Center.
BACKGROUND
Removal of tunneled dialysis catheters (TDC) usually occurs in dedicated procedure suites and is performed relatively rarely at the bedside. Scarce evidence exists in the literature to assess the safety and success of this procedure when performed during supervised academic training.


METHODS
We conducted a retrospective chart review of all TDC removals performed on an outpatient basis by nephrology fellows under faculty supervision during a 5-year period at an academic Veterans Affairs Medical Center. Data were collected regarding patient demographics, basic laboratory studies, pertinent clinical information and procedure-related variables. We evaluated the safety, success and complication rate of this procedure.


RESULTS
We identified 72 TDC removals that met the above criteria. Mean age was 63 ± 10 years. All patients were male and hypertensive, 68% were diabetic and 69% were African-American. Overall, 88% of procedures were performed in end-stage renal disease (ESRD) patients, while the rest had needed temporary dialysis for acute kidney injury. Notably, 49 patients (68%) were taking one or more of aspirin, clopidogrel or warfarin at the time of TDC removal. Overall complication rate was low (&lt;2%). There was no increase in risk of bleeding, even in subjects receiving anti-platelet therapy; only one of the 49 patients (2%) had a minor bleeding complication.


CONCLUSIONS
Outpatient TDC removal by trainees was successful and safe in the vast majority of cases (99%). We propose that TDC removal skills should be actively pursued and acquired by all nephrology fellows. This would expand the scope of practice for future general nephrologists and facilitate timely patient care.
Department of Medicine, Nephrology Section, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana - USA.|Department of Internal Medicine, Nephrology Section, Louisiana State University Health Shreveport, School of Medicine, Shreveport, Louisiana - USA.
Neville R
NR
Dossabhoy
Department of Medicine, Nephrology Section, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana - USA.|Department of Internal Medicine, Nephrology Section, Louisiana State University Health Shreveport, School of Medicine, Shreveport, Louisiana - USA.|Hospitalist and Critical Care Medicine Services, Baylor Scott and White Health, Temple, Texas - USA.
Bhupinder
B
Sangha
Fresenius Medical Care, Semmelweis University, Budapest - Hungary.
Mihály B
MB
Tapolyai
Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi - USA.
Tibor
T
Fülöp
D000046:Academic Medical Centers; D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002983:Clinical Competence; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods*; D004867:Equipment Design; D005257:Fellowships and Scholarships; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072104:Nephrologists / Q000193:education*; D009398:Nephrology / Q000193:education*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors