Access failure with dysfunctional tunnelled haemodialysis catheter in the presence of exit-site infection: Therapeutic challenge – Modified exchange technique

Kishor Kumar Rajasekaran, Abirami Krishnan, Santhosh Kumar

Department of Nephrology, Kauvery Hospital, Salem

Background

Over-the-wire exchange is standard treatment for patients with tunneled hemodialysis catheters (THCs) that fail to maintain sufficient extracorporeal blood flow. However, this well-known procedure is unsuitable in the presence of exit-site infection (ESI). We report successful replacement of THC using a modified exchange technique in a patient with ESI.

Case presentation

A 56 years female, diagnosed to have ESRD on maintenance hemodialysis, weekly thrice, for last 5 years, had multiple access failure with current access being right subclavian tunnelled catheter.

She had flow issues, which demanded permcath exchange. On top of this, she also had exit site infection. (Fig 1). Modified exchange technique was performed by creating a new tunnel avoiding the current exit site to reach the old tunnel thereby securing access. (Fig 2-6). Flow was good in both lumen and the old catheter was removed. (Fig 7).

Conclusion

Exchange of dysfunctional THCs with ESI through remote exit sites and pre-existing subcutaneous tunnels is safe. This modified exchange technique can be used repeatedly in patients prone to ESI, such as the bedridden. This approach needs only a small modification from the traditional over-the-wire technique and is technically uncomplicated. It also offers an alternative for operators who are reluctant to perform over-the-wire exchange through exit sites with questionable hygiene.

Dr. Kishor Kumar R - Top Nephrologist in Salem

Dr. Kishor Kumar R
Consultant – Nephrology

Dr. K.ABIRAMI Nephro

Dr. Abirami Krishnan
Nephrologist

Dr. P. Santhoshkumar

Dr. P. Santhosh Kumar
Consultant Radiologist

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