title: Bedside Tunneled Dialysis Catheter Removal-A Lesson Learned From Nephrology Trainees.
abstract: Semi-permanent dual-lumen tunneled (or tunneled-cuffed) hemodialysis catheters (TDC) are increasingly utilized during renal replacement therapy, while awaiting permanent access maturation or renal recovery. Although there is a wealth of literature focused on placement, infection prevention, and maintenance of catheter patency, circumstances and indications for TDC removal are less well understood. Timely removal of these catheters is an important management decision, with the length of TDC duration representing the largest cumulative risk factor for catheter-associated blood stream infections. Waiting for assistance from surgical or radiological services-which may not be available in all hospitals-may result in delays in services and potential harm to the patients. Imparting and maintaining procedural skills to remove infected TDC may be very valuable for training programs in clinical nephrology. In this article the current literature on bedside TDC removal, including potential anticipated complications during removal, are reviewed. To date, the authors have documented successful implementation of bedside TDC removal in training programs from two different settings, including both in- and outpatients and with trainee involvement. In summary, training general nephrologists for bedside TDC removal will afford immediate removal of infected hardware in ill patients and avoid potential delays in outpatient setting.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Tibor
authors.identifier: http://orcid.org/0000-0002-3346-7040
authors.initials: T
authors.lastname: Fülöp
authors.affiliation: Fresenius Medical Care, Semmelweis University, Budapest, Hungary.
authors.forename: Mihály B
authors.initials: MB
authors.lastname: Tapolyai
authors.affiliation: Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Lopez-Ruiz
authors.affiliation: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Department of Medicine, Nephrology Section, Overton Brooks Veterans Affairs Medical Center.|Department of Internal Medicine, Nephrology Section, Louisiana State University Health-Shreveport, School of Medicine, Shreveport, LA, USA.
authors.forename: Neville R
authors.initials: NR
authors.lastname: Dossabhoy
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D061807:Catheter Obstruction / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D020878:Device Removal / Q000009:adverse effects / Q000193:education*; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D009398:Nephrology / Q000193:education*; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: -C-reactive protein; -End-stage renal disease; -Graduate medical education; -Hemodialysis; -Infection; -Troponin-I; Catheter-related bacteremia