Abstract No. 327 - TETHC—a novel technique for treatment of tunnel/exit site infections in catheter dependent hemodialysis patients with central venous stenosis and limited venous access options

Abstract

Purpose To evaluate the viability and effectiveness of a novel technique of temporary externalization of a tunneled hemodialysis catheter (TETHC) in catheter-dependent hemodialysis patients presenting with catheter-related tunnel/exit site infection, central venous stenosis and limited alternative venous access. Materials and Methods All catheter-dependent hemodialysis patients with documented central venous stenosis presenting with catheter-related infection of the exit site or tunnel who had subsequently undergone TETHC between February 2008 and May 2012 were reviewed. Patients were concurrently treated with intravenous antibiotics prior to reinsertion of a new tunneled hemodialysis catheter. Treatment outcomes were collected, with treatment failures defined as re-infection with the same organism within 45 days of catheter reinsertion. Results Forty-two TETHC procedures were performed in 26 patients. Indications included 20 tunnel infections and 22 exit site infections. The technical success rate for temporary catheter placement was 100%, with no intra-procedural complications and preservation of the original venous access site in all patients. Treatment failure occurred in 9.8 % (4/41) of cases. One patient died prior to reinsertion of the new tunnelled dialysis catheter due to catheter related bacteremia unrelated to the procedure. The median infection free survival of the new tunneled dialysis catheters was 80 days. Post-procedural complications were encountered in four patients and included 3 cases of a small persistent wound at the temporary supraclavicular access site and 1 non-functioning temporary externalized catheter. Conclusion The novel use of TETHC appears safe and is both viable and effective in the treatment of exit-site and tunnel infections while allowing preservation of the venous access site in catheter-dependent hemodialysis patients with central venous stenosis and limited alternative venous access.