Replacement of accidentally removed tunneled venous catheters through existing subcutaneous tracts.

Purpose: The authors describe their experience with reinsertion of accidentally removed tunneled venous catheters using existing subcutaneous tracts.

Materials And Methods: Replacement of 13 dislodged tunneled venous catheters was attempted a median of 12 hours (range, 3 hours to 5 days) after accidental removal. The catheters were needed for hemodialysis (n = 11), plasmapheresis (n = 1), or antibiotic therapy (n = 1). The tunnel exit was probed in the same fashion as for a dislodged nephrostomy tube, and new catheters were reinserted once a guide wire was advanced into the central veins. The medical record was reviewed to determine materials used and occurrence of complications, if any.

Results: Replacement was successful in 12 of 13 patients. The remaining patient had a new catheter placed through a fresh puncture during the same visit. There were no infections associated with re-use of existing tunnels. In five patients, after probing the tract with a guide wire, new catheters were simply advanced into the desired position. Seven other successes required additional manipulations with use of dilators and peel-away sheaths.

Conclusions: Tunneled catheters that "fall out" can be readily replace even when reinsertion is attempted up to 5 days later. This represents an important contribution that radiologists can offer in the management of venous access cases.