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Abstract

Aims and Objectives: To compare the two techniques of tunneled catheter (TC) insertion for hemodialysis; denovo and conversion of uncuffed catheter. Methods: The patients who underwent tunneled catheter insertion from August 2014 to December 2016 at EMS memorial cooperative hospital & research center, Perinthalmanna, Kerala, were included in the study. Technical success, complications, hemodialysis records and clinical outcomes were analyzed. Results: The study group consisted of 42 patients (26 males and 16 females) with age of 58.19±11.72 years. In 28 patients uncuffed catheters (UC) were placed initially &were converted later TC, with minor oozing in 3 (10.71%) subjects. The duration on UC ranged from 3296 days (Range: 3296, Mean: 52.82, SD: 66.36) prior to their conversion to TC. In 14 patients the TC were inserted denovo, with one (7.14%) of them developing pneumothorax and another (7.14%) having minor oozing.The total number of followup days with TC was 12,946 (Range: 3872, Mean: 308.24, SD: 245.30). Ten patients had blood culture proven sepsis, yielding a catheter infection rate of 0.77/1000 catheter days, one among them required TC removal due to unresponsive septicemia (0.08/1000 catheter days). The patency rate of TC was 97.62% at 30 days after insertion, with 20(47.62%) catheters functioning at the end of the study period. Sixteen(38.09%) patients died with working catheters of causes unrelated to catheter and one (2.38%) had CRBSI along with other comorbidities at time of death. The catheters removed in 5 (11.90%) patients when they were no longer needed. There was no statistically significant effect of technique of TC insertion (denovo insertion or conversion of uncuffed catheter) on its durability (p: 0.43), postprocedure complications (p:0.34), CRBSI (p:0.30) and (patient mortality (p:0.29). Conclusions: Thus both techniques of TC insertion are safe and effective. The conversion of a UC to a TC using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.

Keywords: Hemodialysis; Uncuffed Catheter; Tunneled Catheter.

  

Corresponding Author : Lakshminarayana G.R., Consultant Nephrologist, Department of Nephrology, EMS Memorial Cooperative Hospital and Research Centre, Perinthalmanna, Malappuram, Kerala, India679322.