The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees

Abstract

Background: Some nephrologists remove tunneled hemodialysis catheters (TDC) at the bedside, but this practice has never been formally studied. Our hypothesis was that bedside removal of TDC is a safe and effective procedure affording prompt removal, including in cases of suspected infection. Methods: We reviewed our consecutive 3-year experience (2007–2009) with bedside TDC removal at the University of Mississippi Renal Fellowship Program. Data were collected on multiple patients and procedure-related variables, success and complication rates. Association between clinical characteristics and biomarkers of inflammation and myocardial damage was examined using correlation coefficients. Results: Of 55 inpatient TDC removals (90.9% from internal jugular location), 50 (90.9%) were completed without hands-on assistance from faculty. Indications at the time of removal included bacteremia, fever or clinical sepsis with hemodynamic instability or respiratory failure. All procedures were successful, with no cuff retention noted; one patient experienced prolonged bleeding which was controlled with local pressure. Peak C-reactive protein (available in 63.6% of cohort) was 12.9 ± 8.4 mg/dL (reference range: <0.49) and median troponin-I (34% available) was 0.534 ng/mL (IQR 0.03–0.9) (reference range: <0.034) and they did not correlate with each other. Abnormal troponin-I was associated with proven bacteremia (p < 0.05) but not with systolic and diastolic BP or clinical sepsis. Conclusion: Our results suggest that bedside removal of TDC remains a safe and effective procedure regardless of site or indications. Accordingly, TDC removal should be an integral part of competent Nephrology training.

• Bacteremia
• catheter-related bacteremia
• C-reactive protein
• hemodialysis
• tunneled dialysis catheter
• troponin-I

Acknowledgements

Drs. Naseem A. Qureshi and Vikram R. Beemidi are former Nephrology Fellows of the University of Mississippi Medical Center, Years 2010–2012. Dr. Beemidi currently affiliated with Northwest Mississippi Regional Medical Center in Clarksdale, MS and Dr. Qureshi currently in private practice in Jackson, MS. Dr Kamel A. Gharaibeh currently a third-year Internal Medicine Resident at the University of Mississippi Medical Center. Dr. Mihaly Tapolyai is currently employed at WJB Dorn VA Medical Center, University of South Carolina, Columbia, SC.

We sincerely appreciate the dedicated clinical care of our Nephrology trainees form the years past, making this paper possible: Frederick Lee, Brandon Bean, Son G. Lam, Minesh B. Pathak, Adrian Cosmin, Mohit Ahuja, Gurvinder S. Suri, David E. Pruett, R Sellors Meador, Michael Shoemaker-Moyle, Justin H. Bain, and Derrick Tesseneer. We appreciated the help of Ms. Kathryn L. Roberson, R.N. to review the manuscript for English and grammar. We are also thankful for the statistical advice from Zsolt Lengvarszky, M.S., Ph.D. from Louisiana State University Shreveport, Shreveport, LA.

Preliminary data from this study has been presented in an abstract format at ASN Kidney Week 2011, Philadelphia, PA (PO1960); J Am Soc Nephrol. 22, 2011: 568 A and at the SSCI Meeting, New Orleans, LA (P253); J Investigative Med. 2013 (Feb); 61(2): 444.