Background: To estimate the feasibility and clinical outcomes of conversion of temporary to permanent hemodialysis catheters using the same venous insertion site. Methods: The data of patients who underwent conversion of central venous catheter (CVC) from temporary to permanent type from November 2104 to December 2016 at EMS memorial co-operative hospital & research center, Perinthalmanna, Kerala, was analyzed. The conversion of catheter was performed at the existing venous access site under local anesthesia in operation theater with the guidance of C-ARM. Technical success, procedural complications, hemodialysis records and clinical outcomes were evaluated. Results: The study group consisted of 26 patients (14 males and 12 females)with age of 56.61 ±10.13 years. All 26 temporary catheters were successfully converted to permanent or tunneled hemodialysis catheters with 3 patients having minor oozing and no major procedure-related complications. The duration on temporary catheters ranged from 3-296 (mean: 53.42) days prior to their conversion to permanent type, after failure of multiple attempts at arterio-venous (AV) fistula creation. Heparin (5000 U/ml) along with Cefazoin (10 mg/ml) in ratio of 1:1 were used as locking solution and Mupirocin ointment was applied at exit site for both temporary & permanent catheters(PC) after each dialysis to reduce the incidence of catheter related blood stream infections (CRBSI). The total number of follow-up days with permanent catheter (PC) was 6730 (range:33-768, mean: 258.85, SD: 199.47). There were 8 events of culture proven sepsis, yielding a catheter infection rate of 1.2/1000 catheter days, one among them required PC removal due to unresponsive septicemia (0.14/1000 catheter days).None of them had exit site infection, tunnel infection requiring catheter removal. The patency rate was 96.15% at 30 days after insertion, with 9 catheters functioning at the end of the study period. One patient needed repostioning of PC due to poor blood flow within one week after insertion. Thirteen patients died with working catheters of causes unrelated to catheter. The catheters removed in 4 patients when they were no longer needed (access changed to AV graft in 2, AV fistula in 1, and 1 patient had improvement in renal parameters). Two patients required replacement with new PC (PC related septicemia in one and due inadvertent removal in another). Conclusions: Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites. The conversion also avoids complications associated with venotomy and allows conservation of other central venous access sites. Use of Heparin (5000 U/ml) along with Cefazoin (10 mg/ml) in ratio of 1:1; as locking solution and Mupirocin ointment for application at exit site for both TC & PC is an effective strategy to reduce the incidence of catheter related infections.

Keywords: Hemodialysis; Temporary Catheter; Permanent or Cuffed Catheter.