Department of Internal Medicine and Nephrology, Institute of Medical Sciences, University of Opole, Opole, Poland.
Department of Internal Medicine and Nephrology, University Hospital,, Opole, Poland.
Sci Rep. 2020 May 18;10(1):8162. doi: 10.1038/s41598-020-64985-3.
Despite all efforts, still many end-stage kidney disease (ESKD) patients are dialysed using a central tunnelled catheter (CTC) as vascular access. When the CTC blood flow becomes ineffective, a number of protocols are advised. However, all of them are time- and cost-consuming. The manoeuvre of a non-invasive tunnelled catheter reposition (NTCR) was introduced to restore the CTC function. NTCR was based on gentle movements of the CTC, with or without a simultaneous flushing of the CTC lines, which resulted in a quick reposition of the CTC tip. This study comprises the analysis of a total of 297 NTCRs, which were performed in 114 patients, thus enabling an effective blood flow after 133 procedures (44.7%).Partially effective blood flow followed 123 procedures (41.4%), and it failed altogether in 41 cases (13.9%). Overall, 86% of conducted NTCRs improved the CTC patency to perform a haemodialysis session. The procedure could be successfully repeated, with a similar result after the first and the second attempt. Complications were observed only after 3.4% of all interventions. The novel NTCR manoeuvre was safe and effective in the majority of the CTC dysfunction episodes. It seemed to reduce fibrinolytic usage, allowed an immediate haemodialysis session commencement, therefore, it might save both the costs and the nursing staff time.
尽管已经付出了所有努力，仍有许多终末期肾病（ESKD）患者使用中央隧道导管（CTC）作为血管通路进行透析。当 CTC 血流变得无效时，建议采用多种方案。然而，所有这些方案都既耗时又费钱。引入非侵入性隧道导管重新定位（NTCR）操作，旨在恢复 CTC 的功能。NTCR 基于 CTC 的轻柔运动，可同时或不同时冲洗 CTC 管路，从而快速重新定位 CTC 尖端。本研究共分析了 114 名患者的 297 次 NTCR，其中 133 次（44.7%）操作后实现了有效的血流。123 次（41.4%）操作后实现了部分有效的血流，41 次（13.9%）操作完全失败。总体而言，86%的 NTCR 操作改善了 CTC 的通畅性，从而能够进行血液透析。该操作可以成功重复，第一次和第二次尝试的结果相似。所有干预措施中仅观察到 3.4%的并发症。新型 NTCR 操作在大多数 CTC 功能障碍发作中既安全又有效。它似乎减少了纤维蛋白溶解的使用，允许立即开始血液透析，因此可以节省成本和护理人员的时间。
