Giacomo Forneris1, Daniele Savio2, Pietro Quaretti3, Massimo Lodi4, Simone Comelli5, Walter Morale6, Monica Spina7, Luca Di Maggio2, Marina Cornacchiari8, Massimo Punzi9, Giuseppe Gatta10, Pasqualina Cecere11, Marco Pozzato11, Antonio Marciello12, Dario Roccatello11. 1. CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, G. Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy. gforneris62@gmail.com. 2. Interventional Radiology Unit, Radiology Department, G. Bosco Hospital, Turin, Italy. 3. Interventional Radiology Unit, Radiology Department, IRCCS Policlinico San Matteo, Pavia, Italy. 4. Nephrology and Dialysis, Spirito Santo Hospital, Pescara, Italy. 5. Division of Neuroradiology and Interventional Radiology, AO Brotzu, Cagliari, Italy. 6. Nephrology and Dialysis, A.O. Cannizzaro, Catania, Italy. 7. Nephrology and Dialysis, NS di Bonaria, San Gavino Monreale, VS, Italy. 8. Nephrology Unit, Asst Ovest Milanese-Magenta Hospital, Milan, Italy. 9. Vascular Access Service for Hemodialysis, Nephrocare, Rome, Italy. 10. Department of Nephrology and Dialysis, Scientific Institute for Research and Health Care "Casa Sollievo della Sofferenza" IRCCS, San Giovanni Rotondo, Italy. 11. CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, G. Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy. 12. Division of Nephrology and Dialysis, ASL TO3 di Collegno Pinerolo, PO "Edoardo Agnelli", Pinerolo, Italy.
Abstract
BACKGROUND: Reports of stuck hemodialysis catheters have been on the rise in recent years. Aim of this work is to report how this complication has been managed and the relative outcomes in a multicente Italian survey. METHODS: Since 2012, the Italian Society of Nephrology (SIN) Project Group of Vascular Access has collected data among nephrologists on this complication. Data regarding 72 cases of stuck tunnelled central venous catheter (tCVC) in 72 patients were retrieved thanks to this survey. RESULTS: In 11 patients (15%) the stuck catheter was directly buried or left in place. Sixty-one cases were managed through advanced removal techniques. Among these, 47 (77%) stuck tunnelled central venous catheters were successfully removed, while 14 (23%) failed to be withdrawn. Considering removed tCVCs, the use of endoluminal balloon dilatation alone or in combination with other tools showed a percentage of success of 88%. The removal procedure involved numerous specialists. Some complications occurred, such as breakage of the line or bleeding, and two cases of haemopericardium during an advanced procedure. CONCLUSION: The survey shows how the stuck catheter complication was managed in different ways, with conflicting results. When utilized, endoluminal balloon dilatation proved to be the most effective and most often utilized technique, while some cases had suboptimal management or failure. This underlines how delicate the procedure is, and the need for both precise knowledge of this complication and timely organization of removal attempts.
BACKGROUND: Reports of stuck hemodialysis catheters have been on the rise in recent years. Aim of this work is to report how this complication has been managed and the relative outcomes in a multicente Italian survey. METHODS: Since 2012, the Italian Society of Nephrology (SIN) Project Group of Vascular Access has collected data among nephrologists on this complication. Data regarding 72 cases of stuck tunnelled central venous catheter (tCVC) in 72 patients were retrieved thanks to this survey. RESULTS: In 11 patients (15%) the stuck catheter was directly buried or left in place. Sixty-one cases were managed through advanced removal techniques. Among these, 47 (77%) stuck tunnelled central venous catheters were successfully removed, while 14 (23%) failed to be withdrawn. Considering removed tCVCs, the use of endoluminal balloon dilatation alone or in combination with other tools showed a percentage of success of 88%. The removal procedure involved numerous specialists. Some complications occurred, such as breakage of the line or bleeding, and two cases of haemopericardium during an advanced procedure. CONCLUSION: The survey shows how the stuck catheter complication was managed in different ways, with conflicting results. When utilized, endoluminal balloon dilatation proved to be the most effective and most often utilized technique, while some cases had suboptimal management or failure. This underlines how delicate the procedure is, and the need for both precise knowledge of this complication and timely organization of removal attempts.
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