隧道式血液透析导管在存在隧道或出口部位感染且血管通路选择受限的患者中的外置。

Externalization of tunneled hemodialysis catheter in patients with tunnel or exit-site infections and limited access options.

作者信息

Jaberi Arash, Hadziomerovic Adnan, Toor Sundeep S, Galwa Ramprakash P, Graham Janet, Thornhill Rebecca E, Ryan Stephen E

机构信息

Faculty of Medicine (A.J., A.H., S.S.T., R.E.T., S.E.R.), University of Ottawa, Ottawa, Ontario, Canada; Departments of Radiology (A.J., A.H., S.S.T., R.E.T., S.E.R.).

出版信息

J Vasc Interv Radiol. 2014 Apr;25(4):561-6. doi: 10.1016/j.jvir.2013.12.570.

DOI:10.1016/j.jvir.2013.12.570

PMID:24674214

Abstract

PURPOSE

To evaluate the viability and effectiveness of temporary externalization of a tunneled hemodialysis (HD) catheter in catheter-dependent HD patients presenting with catheter-related tunnel or exit-site infection, documented central venous stenosis, and limited alternative venous access.

MATERIALS AND METHODS

All catheter-dependent HD patients with known central venous stenosis presenting with exit-site or tunnel infection and who subsequently underwent catheter externalization between February 2008 and May 2012 were reviewed. After catheter externalization, patients were concurrently treated with antibiotics for approximately 3 weeks before reinsertion of a new tunneled catheter. Treatment outcomes were collected, with treatment failures defined as reinfection with the same organism within 45 days of tunneled catheter reinsertion.

RESULTS

There were 42 catheter externalization procedures performed in 26 patients for 42 exit-site or tunnel infections. Technical success rate for catheter externalization was 100%, with no complications during the externalization procedure and preservation of all original access sites. Treatment failure occurred in 9.8% (4 of 41) of cases. Median infection-free survival after treatment and retunneling of a new dialysis catheter was 80 days. One major periprocedural complication of death occurred before reinsertion of a new tunneled catheter. Minor complications after the procedure occurred in four patients and included three cases of a small persistent wound at the temporary supraclavicular access site and one initially nonfunctioning externalized catheter.

CONCLUSIONS

Temporary dialysis catheter externalization appears both technically feasible and effective for the treatment of exit-site and tunnel infections, while allowing preservation of the venous access site in catheter-dependent HD patients with central venous stenosis and limited alternative venous access.

摘要

目的

评估带隧道的血液透析（HD）导管临时外置术在依赖导管的HD患者中的可行性和有效性，这些患者存在导管相关的隧道或出口部位感染、有记录的中心静脉狭窄且可供选择的静脉通路有限。

材料与方法

回顾了2008年2月至2012年5月期间所有依赖导管的HD患者，这些患者已知存在中心静脉狭窄，出现出口部位或隧道感染，随后接受了导管外置术。导管外置后，患者在重新插入新的带隧道导管前同时接受约3周的抗生素治疗。收集治疗结果，治疗失败定义为在带隧道导管重新插入后45天内同一病原体再次感染。

结果

26例患者因42处出口部位或隧道感染进行了42次导管外置术。导管外置术的技术成功率为100%，外置过程中无并发症，所有原通路部位均得以保留。9.8%（41例中的4例）的病例出现治疗失败。新透析导管治疗及重新造隧道后的无感染生存中位数为80天。在重新插入新的带隧道导管前发生了1例围手术期主要并发症死亡。术后有4例患者出现轻微并发症，包括3例临时锁骨上通路部位小的持续性伤口和1例最初功能不良的外置导管。