Tunneled hemodialysis catheters are the lifeline to patients on maintenance hemodialysis with failed arteriovenous fistulas. However, thrombosis and infection are the main causes of reduced longevity of these accesses. According to IDSA guidelines, catheter-related infection with Pseudomonas and fungi are absolute indications for catheter removal. Considering the cost and difficulties in catheter replacement, for those in whom all accesses are exhausted, retaining the same catheter may be lifesaving. We would like to present two patients in whom, 70% ethanol instillation was used to eradicate infection with these organisms as confirmed by repeat cultures post procedure. Hemodialysis is being successfully continued through the same catheter.
Background: The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.
Objectives: Femoral vein transposition (tFV) is a complex procedure that provides high patency rates for patients with exhausted upper-limb vascular access. Traditionally, the procedure involves a long single incision in the thigh to harvest the femoral vein, but this approach is associated with increased risks of local complications such as infections and haematomas. Skip incisions have shown to lower complication rates and shorten maturation times.
In hemodialysis-related portal-systemic encephalopathy (HRPSE), transient negative pressure in the inferior vena cava (IVC) during dialysis increases the blood flow through a portal-systemic shunt, leading to encephalopathy. We report the case of a 74-year-old man with a gastrorenal shunt who developed HRPSE for the first time following venous occlusion due to thrombosis around a right femoral tunneled-cuffed hemodialysis catheter. Before the thrombosis dissolved, ammonia levels increased after dialysis.
Tunneled dialysis catheter is the alternative for dialysis patients who cannot benefit from an arteriovenous fistula. The insertion of such catheters is usually ultrasound-guided to prevent complications. A 36-year old patient had an unexpected complication following the insertion of a right femoral tunneled dialysis catheter: Although the blood collected from the catheter was venous after insertion, the blood turned arterial few minutes after initiating a continuous renal replacement therapy (CRRT).
Hemodialysis (HD) access failure is a frequent problem encountered by vascular surgeons. As treatment of end-stage renal disease improves and patients live longer on HD, eventual exhaustion of traditional upper extremity HD access is common. Efforts to preserve and maintain these accesses are essential.
