Fülöp Tibor, Tapolyai Mihály B, Agarwal Mohit, Lopez-Ruiz Arnaldo, Molnar Miklos Z, Dossabhoy Neville R
Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
Fresenius Medical Care, Semmelweis University, Budapest, Hungary.
Artif Organs. 2017 Sep;41(9):810-817. doi: 10.1111/aor.12869. Epub 2016 Dec 26.
Semi-permanent dual-lumen tunneled (or tunneled-cuffed) hemodialysis catheters (TDC) are increasingly utilized during renal replacement therapy, while awaiting permanent access maturation or renal recovery. Although there is a wealth of literature focused on placement, infection prevention, and maintenance of catheter patency, circumstances and indications for TDC removal are less well understood. Timely removal of these catheters is an important management decision, with the length of TDC duration representing the largest cumulative risk factor for catheter-associated blood stream infections. Waiting for assistance from surgical or radiological services-which may not be available in all hospitals-may result in delays in services and potential harm to the patients. Imparting and maintaining procedural skills to remove infected TDC may be very valuable for training programs in clinical nephrology. In this article the current literature on bedside TDC removal, including potential anticipated complications during removal, are reviewed. To date, the authors have documented successful implementation of bedside TDC removal in training programs from two different settings, including both in- and outpatients and with trainee involvement. In summary, training general nephrologists for bedside TDC removal will afford immediate removal of infected hardware in ill patients and avoid potential delays in outpatient setting.
半永久性双腔带隧道（或带隧道带套囊）血液透析导管（TDC）在肾脏替代治疗期间，等待永久性血管通路成熟或肾脏恢复过程中越来越多地被使用。尽管有大量文献聚焦于导管的置入、感染预防及保持通畅，但TDC拔除的情况和指征却鲜为人知。及时拔除这些导管是一项重要的管理决策，TDC留置时间是导管相关血流感染的最大累积风险因素。等待外科或放射科服务的协助（并非所有医院都能提供）可能导致服务延误并对患者造成潜在伤害。传授并维持拔除感染TDC的操作技能对临床肾脏病培训项目可能非常有价值。本文对目前关于床边拔除TDC的文献进行综述，包括拔除过程中可能预期的并发症。迄今为止，作者记录了在两种不同环境的培训项目中成功实施床边拔除TDC，包括门诊和住院患者以及有实习医生参与的情况。总之，培训普通肾脏病医生进行床边拔除TDC将能立即为患病患者拔除感染的装置，并避免门诊环境中的潜在延误。
