POS-578 SHORT TERM OUTCOMES OF TUNNELED CUFFED CATHETERS- A SINGLE CENTER EXPERIENCE

Abstract

Tunneled cuffed catheters (TCC) for hemodialysis (HD) play an important role in the patients who require HD for a short time till renal recovery or in patients who are on maintenance HD and lack a functioning arterio-venous fistula (AVF). A retrospective analysis of clinical parameters of all the patients who were put TCC from October 2017 to September 2020 (3 years) was done with follow up from, minimum of 1 month to 3 years. All tunneled catheters were inserted under ultrasound guidance by a trained Nephrologist. A post-insertion chest radiograph was done to confirm the catheter position. All complications and catheter survival were recorded. A total of 128 TCC were put, out of which 3 were repeat, 1 femoral and 1 left sided internal jugular vein (IJV) and rest all were right sided tunneled IJV catheters. Prolonged exit site bleeding was most common procedure related complication (9.6%), and beside this there was no procedure related mortality or significant morbidity. Chronic kidney disease (CKD) of undetermined etiology (44.8%), Diabetes mellitus (40.8%) and IgA Nephropathy (5.6%) were the leading causes of ESRD. Most common indication for inserting TCC was initiation of HD (81.6%), followed by failed AVF (15.2%) and failed peritoneal dialysis (PD) (3.2%). Among 125 TCC, 5 blocked {3 required removal (mean 55.6 days) and 2 were opened with instillation of streptokinase}, 3 had catheter-related blood stream infection (CABSI) (mean 48 days) and required removal and 2 catheters slipped spontaneously (mean 68 days). Overall percentage of functioning catheter was (93.6%). Average catheter survival i.e. including death with functioning catheter, elective catheter removal after AVF creation, kidney transplant and renal recovery beyond one month of catheter insertion (7 patients died with functional catheter in less than a month of insertion) was 142.8 days. Need of the HD initiation was the most common indication for insertion of TCC. Exit site bleeding (9.6%) was the most common procedure related complication and overall percentage of functioning TCC was 93.6%. Although AVF is best mode of vascular access for HD, TCC insertion is safe, immediate and effective mode of vascular access. TCC plays a successful role in patients who require unplanned HD initiation and those with failed AVF.