title: The risk of bleeding with tunneled dialysis catheter placement.
abstract: The purpose of this study was to evaluate the risk of bleeding associated with tunneled dialysis catheter (TDC) placement in a large population of hemodialysis patients who were either anticoagulated or were taking antithrombotic medications.
  
  
  
  Medical records obtained over a two-year period were queried in order to select two groups of study cases. The first was a Med group (n = 458), cases which had a TDC placed while taking the antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid [ASA]) which were not discontinued or held. The second was a Declot Failure (DF) group (n = 941) and consisted of cases in which a TDC had been placed immediately following a failed arteriovenous access thrombectomy procedure in which they had been anticoagulated using unfractionated heparin. The results obtained in these two groups were compared to the incidence of bleeding observed in a cohort of 6555 TDC placements that had been performed previously referred to as the Control group.
  
  
  
  The incidence of bleeding in the Control group was 0.46%. The incidence of bleeding in the DF group was 0.44% and in the Med group was 0.36%. No patient had bleeding that required transfusion, hospitalization, or catheter removal.
  
  
  
  Based upon these data, it seems reasonable to classify the TDC placement procedure as having a very low risk of bleeding and to not require preprocedure laboratory testing. The value of suspending antithrombotic medications prior to TDC placement cannot be supported.
authors.affiliation: Lifeline Vascular Access, Houston, Texas - USA.|University of Texas Medical Branch, Galveston, Texas - USA.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Beathard
authors.affiliation: Lifeline Vascular Access, Houston, Texas - USA.
authors.forename: Aris
authors.initials: A
authors.lastname: Urbanes
authors.affiliation: Lifeline Vascular Access, Houston, Texas - USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Litchfield
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008499:Medical Records; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents