Prevention of Damage to Cuffed Catheters

Abstract

Cuffed catheters, although not ideal for long-term use, are now used more frequently due to an increase in the aging population, in whom the vessels are not suitable for either arteriovenous fistulas or polytetrafluoroethylene (PTFE) grafts. Infections and thrombosis remain the major causes for removal or change of catheters. We recently identified eight catheter defects that required replacement of catheters. Of these, two were due to patient negligence: one catheter was accidentally severed while the patient was shaving; the other was snipped during a haircut. One was believed to have a manufacturing defect. One catheter sustained needle-prick damage near the hub while irrigating the catheter. Two catheters were lost due to needle pricks during skin closure, and one catheter sustained similar damage while fixing the suture wing to the skin. The other two were damaged by suture material slicing through the lumen of the catheter as it expanded due to increased blood flow during repeated dialyses. Importantly, several of these injuries to the catheters were not immediately obvious and were detected only after repeated use of the catheters. Delayed bleeding of cuffed catheters necessitating change or removal has not been reported. Such bleeding may be due to manufacturing defects, patient carelessness, or iatrogenic causes. Avoiding the use of sutures can minimize the latter. Skin closure strips and a double transparent dressing may serve the same purposes, such as securing the catheter and aiding wound healing. In addition, these dressings have the added advantage of being waterproof, bacteria-proof, and cost effective.