The stuck haemodialysis catheter-a case report of a rare but dreaded complication following kidney transplantation.
Case report
Central cuffed catheter
Haemodialysis
Interventional radiology
Stuck permcath
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
18 Mar 2024
18 Mar 2024
Historique:
received:
04
12
2023
accepted:
17
02
2024
medline:
19
3
2024
pubmed:
19
3
2024
entrez:
19
3
2024
Statut:
epublish
Résumé
Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming 'stuck' via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period. A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications. This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.
Sections du résumé
BACKGROUND
BACKGROUND
Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming 'stuck' via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period.
CASE PRESENTATION
METHODS
A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications.
CONCLUSIONS
CONCLUSIONS
This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.
Identifiants
pubmed: 38500070
doi: 10.1186/s12882-024-03507-z
pii: 10.1186/s12882-024-03507-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
104Informations de copyright
© 2024. The Author(s).
Références
Lok C, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 update. Am J Kidney Dis. 2020;75(4 Suppl 2):1–S164. https://doi.org/10.1053/j.ajkd.2019.12.001 .
doi: 10.1053/j.ajkd.2019.12.001
Forneris G, et al. Report on an Italian survey of 72 stuck hemodialysis catheters. J Nephrol. 2023;36:359–65.
doi: 10.1007/s40620-022-01474-y
pubmed: 36269492
Ryan SE, et al. Endoluminal Dilation Technqiue to remove Stuck Tunnelled Hemodialysis catheters. Radiology. 2012;23(8):1089–93.
Thein H, Ratanjee SK. Tethered hemodialysis catheter with retained portions in Central Vein and Right Atrium on attempted removal. AJKD. 2005;46(3):e35–9.
doi: 10.1053/j.ajkd.2005.05.030
pubmed: 16129197
Bhutta ST, Culp WC. Evaluation and management of central venous Access complications. Tech Vasc Interv Radiol. 2011;14(4):217–24.
doi: 10.1053/j.tvir.2011.05.003
pubmed: 22099014
Vellanki, et al. The Stuck catheter: a hazardous twist to the meaning of permanent catheters. J Vasc Access. 2015;16(4):144–8.
doi: 10.5301/jva.5000392
Hong JH. A breakthrough technique for the removal of a Hemodialysis Catheter Stuck in the Central Vein: Endoluminal Balloon Dilatation of the Stuck Catheter. JVA. 2011;12(3):381–4. https://doi.org/10.5301/JVA.2011.8415 .
doi: 10.5301/JVA.2011.8415
pubmed: 21688240
Quaretti, et al. A refinement of Hong’s technique for the removal of stuck dialysis catheters: an easy solution to a complex problem. J Vasc Access. 2014;15(3):183–8.
doi: 10.5301/jva.5000186
pubmed: 24190073
Ebad, et al. Application of Hong’s technique for removal of stuck hemodialysis tunneled catheter to pacemaker leads. Radiol Case Rep. 2017;12(1):97–101.
Forneris G, et al. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol. 2014;27:619–25.
doi: 10.1007/s40620-014-0150-4
pubmed: 25319545
Carrillo RG, Garisto JD, Salman L, Merrill D, Asif RA. Novel technique for tethered Dialysis catheter removal using the laser sheath. Semin Dial. 2009;22(6):688–91.
doi: 10.1111/j.1525-139X.2009.00646.x
pubmed: 20017840
Troidle L, Eisen T, Finkelstein FO. Why do so many patients have a Dialysis Catheter and not arteriovenous fistulae or grafts? Hemodial Int. 2004;8(1):80–1.
doi: 10.1111/j.1492-7535.2004.0085h.x
Shamasneh AO, et al. Perceived barriers and attitudes toward arteriorvenous fistula creation and use in hemodialysis patients in Palestine. Ren Fail. 2020;42(1):343–9.
doi: 10.1080/0886022X.2020.1748650
pubmed: 32338112
pmcid: 7241481