Abstract
The Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines recommend placement of the tip of the jugular tunneled dialysis catheter in the right atrium to maximize blood flow and avoid TDC malfunction. However, some dialysis catheter tips are placed in the cavoatrial junction and at various locations within the right atrium. To evaluate factors associated with TDC placement requiring exchange for malfunctioning, we reviewed our experience with TDC exchanges performed for malfunction. Review of imaging and medical charts was performed for TDC exchanges for malfunction by interventional radiology at a large academic institution for the past 6 years. Patient demographics, device used, date of placement, date of exchange and catheter tip positions were reviewed. A total of 62 jugular dialysis catheters were exchanged for malfunction over 6 years, 59 of which were straight step-tip catheters (such as the MedComp Titan) and 3 of which were either angled step-tip catheters (such as the AngioDynamics Duramax) or split-tip catheters (such as the MedComp AshSplit). The vast majority of the catheter tips, 75.8%, were located in the mid- or superior one-third of the right atrium prior to exchange. Only 24.2% were located in the bottom one-third of the right atrium. No cases involved non-straight step-tip catheters with their tips located in the bottom one-third of the right atrium. Excluding TDCs that required more than one exchange, only 1 non-straight step-tip catheters was exchanged. The median duration of the prior catheter prior to exchange was 30.5 days. None of the TDCs were exchanged for arrhythmia. At a large academic medical center over 6 years, the vast majority of tunneled dialysis catheters exchanged for malfunction were straight step-tip catheters and located in the superior or middle one-third of the right atrium. No cases involved non-straight step-tip catheters with their tips located in the bottom one-third of the right atrium. None of the TDCs were exchanged for arrhythmia.
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