Abstract No. 440 Effectiveness of epinephrine containing lidocaine in decreasing bleeding complications after tunnel dialysis catheter placement

Abstract

Minor bleeding and oozing from a tunnel dialysis catheter (TDC) insertion site is a common occurrence with a prevalence of between 0% to 42% in literature. However, the risk of significant bleed that results in catheter failure is much lower. To alleviate such bleeding complication, interventional radiologist may preferentially choose Lidocaine with epinephrine mixture instead of plain Lidocaine for local anesthetic at the incision site and within the subcutaneous tunnel during the process of insertion of the catheter. The goal of this study is to identify if there is a difference in the outcome of postprocedural bleeding in patients who had a Lidocaine with epinephrine versus plain lidocaine anesthetic. A total of 261 patients were evaluated retrospectively to explore the association between bleeding complications and the use of lidocaine with or without epinephrine during tunneled dialysis catheter placement. This was done by paralleling the outcome of an interventional radiologist that exclusively used plain lidocaine for the tunnel site for all TDC placements and a second radiologist who exclusively used lidocaine with epinephrine for the tunnel site for all TDC placements. All patients had the same pre procedure vetting criteria and post procedure care and recommendations. All patients also received a 14.5 French dual lumen Bard TDC. There was no significant difference in postoperative TDC site bleeding with the lidocaine only group versus the lidocaine + epinephrine group, (P >0.99). A total of 261 TDC were placed by the two operators A (Lido) and B (Lido + Epi) in the period that was evaluated. 139 TDC (53.3%) were placed by operator A and 122 TDC (46.7) were placed by operator B. 8 cases (5.76%) had catheter site bleeding after TDC insertion by operator A (Lido) and 7 cases (5.74%) had catheter site bleeding after TDC insertion by operator B (Lido + Epi). The P value was not significant to prove that there was a difference between Lidocaine with Epinephrine and Lidocaine only in this study. Perhaps further investigation on whether patient size or platelet dysfunction or other parameters play a bigger role in bleeding complication rates is necessary.