Analysis of early failure of tunneled hemodialysis catheters

OBJECTIVE. Tunneled hemodialysis catheters are often placed by the interventional radiology service using sonographic guidance and fluoroscopy for safe and optimal placement. The aim of this study was to determine the causes of early failure (less than or equal to7 days) of these catheters in our practice. SUBJECTS AND METHODS. Data were prospectively collected for 639 radiologically placed tunneled hemodialysis catheters. The reason for catheter removal was recorded in each case. Tips of removed catheters were routinely sent for microbial culture. RESULTS. Fifty-two (8.1%) of 639 catheters were removed within 7 days of insertion. Six (0.9%) of these had completed their purpose and had not failed; these were not included in the study. Of the 46 catheters having early failure, six (0.9%) were clotted and 12 (1.9%) were suspected of being infected, only three of which had a proven catheter-related infection. Twenty-eight catheters (4.4%) were removed for other reasons. In this group, the most common reasons were poor tip position (n = 9) and catheter replacement over a guidewire into a preexisting fibrin sheath (n = 8). Only two failed because of poor tip orientation. Other reasons for failure were kinked or pinched catheters (n = 4) and bleeding (it = 3), including one exsanguination, and two unknown reasons. CONCLUSION. By paying careful attention to catheter tip position, searching diligently for the presence of a fibrin sheath when catheter exchanges are made over a wire, and better investigating presumed catheter infection, we could reduce the early failure rate by more than half, from 46 cases to 20 cases (nine cases of suspected infection were in fact not infected).