Department of Medicine, University of Mississippi Medical Center , Jackson, MS , United States .
Ren Fail. 2013 Oct;35(9):1264-8. doi: 10.3109/0886022X.2013.823875. Epub 2013 Aug 7.
Some nephrologists remove tunneled hemodialysis catheters (TDC) at the bedside, but this practice has never been formally studied. Our hypothesis was that bedside removal of TDC is a safe and effective procedure affording prompt removal, including in cases of suspected infection.
We reviewed our consecutive 3-year experience (2007-2009) with bedside TDC removal at the University of Mississippi Renal Fellowship Program. Data were collected on multiple patients and procedure-related variables, success and complication rates. Association between clinical characteristics and biomarkers of inflammation and myocardial damage was examined using correlation coefficients.
Of 55 inpatient TDC removals (90.9% from internal jugular location), 50 (90.9%) were completed without hands-on assistance from faculty. Indications at the time of removal included bacteremia, fever or clinical sepsis with hemodynamic instability or respiratory failure. All procedures were successful, with no cuff retention noted; one patient experienced prolonged bleeding which was controlled with local pressure. Peak C-reactive protein (available in 63.6% of cohort) was 12.9 ± 8.4 mg/dL (reference range: <0.49) and median troponin-I (34% available) was 0.534 ng/mL (IQR 0.03-0.9) (reference range: <0.034) and they did not correlate with each other. Abnormal troponin-I was associated with proven bacteremia (p < 0.05) but not with systolic and diastolic BP or clinical sepsis.
Our results suggest that bedside removal of TDC remains a safe and effective procedure regardless of site or indications. Accordingly, TDC removal should be an integral part of competent Nephrology training.
一些肾病学家在床边移除隧道式血液透析导管（TDC），但这种做法从未经过正式研究。我们的假设是，床边移除 TDC 是一种安全有效的程序，可以快速移除，包括在疑似感染的情况下。
我们回顾了我们在密西西比大学肾脏研究员计划中连续 3 年（2007-2009 年）的床边 TDC 移除经验。收集了多位患者和程序相关变量、成功率和并发症发生率的数据。使用相关系数检查了临床特征与炎症和心肌损伤的生物标志物之间的关联。
在 55 例住院 TDC 移除（90.9%来自颈内静脉位置）中，有 50 例（90.9%）在没有教师协助的情况下完成。移除时的指征包括菌血症、发热或临床败血症伴血流动力学不稳定或呼吸衰竭。所有手术均成功完成，未发现袖口残留；一名患者出现持续出血，通过局部按压控制。可获得 63.6%队列的 C 反应蛋白峰值为 12.9±8.4mg/dL（参考范围：<0.49），中位数肌钙蛋白 I（34%可获得）为 0.534ng/mL（IQR 0.03-0.9）（参考范围：<0.034），两者之间无相关性。异常肌钙蛋白 I 与已证实的菌血症相关（p<0.05），但与收缩压和舒张压或临床败血症无关。
我们的结果表明，无论部位或指征如何，床边移除 TDC 仍然是一种安全有效的程序。因此，TDC 移除应成为肾脏病学培训的一个组成部分。
