The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees

Tibor Fülöp, Mihály Tapolyai, Naseem A. Qureshi, Vikram R. Beemidi, Kamel A. Gharaibeh, S. Mehrdad Hamrahian, Tibor Szarvas, Csaba Kovesdy, Éva Csongrádi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1264-1268
Number of pages5
JournalRenal Failure
Volume35
Issue number9
DOIs
StatePublished - Oct 1 2013

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Nephrology
Renal Dialysis
Catheters
Safety
Troponin I
Bacteremia
Sepsis
Reference Values
Mississippi
Respiratory Insufficiency
C-Reactive Protein
Inpatients
Fever
Neck
Biomarkers
Hemodynamics
Hemorrhage
Inflammation
Kidney
Pressure

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine
  • Nephrology

Cite this

Fülöp, T., Tapolyai, M., Qureshi, N. A., Beemidi, V. R., Gharaibeh, K. A., Hamrahian, S. M., ... Csongrádi, É. (2013). The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees. Renal Failure, 35(9), 1264-1268. https://doi.org/10.3109/0886022X.2013.823875

The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees. / Fülöp, Tibor; Tapolyai, Mihály; Qureshi, Naseem A.; Beemidi, Vikram R.; Gharaibeh, Kamel A.; Hamrahian, S. Mehrdad; Szarvas, Tibor; Kovesdy, Csaba; Csongrádi, Éva.

In: Renal Failure, Vol. 35, No. 9, 01.10.2013, p. 1264-1268.

Research output: Contribution to journalArticle

Fülöp, T, Tapolyai, M, Qureshi, NA, Beemidi, VR, Gharaibeh, KA, Hamrahian, SM, Szarvas, T, Kovesdy, C & Csongrádi, É 2013, 'The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees', Renal Failure, vol. 35, no. 9, pp. 1264-1268. https://doi.org/10.3109/0886022X.2013.823875
Fülöp T, Tapolyai M, Qureshi NA, Beemidi VR, Gharaibeh KA, Hamrahian SM et al. The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees. Renal Failure. 2013 Oct 1;35(9):1264-1268. https://doi.org/10.3109/0886022X.2013.823875
Fülöp, Tibor ; Tapolyai, Mihály ; Qureshi, Naseem A. ; Beemidi, Vikram R. ; Gharaibeh, Kamel A. ; Hamrahian, S. Mehrdad ; Szarvas, Tibor ; Kovesdy, Csaba ; Csongrádi, Éva. / The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees. In: Renal Failure. 2013 ; Vol. 35, No. 9. pp. 1264-1268.
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AU - Beemidi, Vikram R.

AU - Gharaibeh, Kamel A.

AU - Hamrahian, S. Mehrdad

AU - Szarvas, Tibor

AU - Kovesdy, Csaba

AU - Csongrádi, Éva

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N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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