Spontaneous Dislodgement of Tunneled Dialysis Catheters after De Novo versus Over-The-Wire-Exchange Placement |
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| Affiliation: | 1. Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104;2. Biostatistics Consulting, Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania;1. Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico;2. Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584;3. Department of Radiology, Medical Clinic of Houston, Houston, Texas;4. Department of Radiology, Stanford University, Stanford, California;5. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas;1. Division of Interventional Radiology, Department of Radiology, University of Chicago, Billings Hospital, P220, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637;2. University of Illinois College of Medicine, Chicago, Illinois;1. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH 44195;2. Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio;3. School of Medicine, Case Western Reserve University, Cleveland, Ohio;4. Division of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, Ohio;5. Department of Chemical and Biomolecular Engineering, University of Akron, Akron, Ohio;6. Department of Food, Agricultural and Biological Engineering, Ohio State University, Wooster, Ohio;7. Imaging Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio;1. Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 12th Floor, New York, NY, 10029;2. Recanti/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York;3. Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York |
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| Abstract: | PurposeTo evaluate dislodgement of tunneled dialysis catheters (TDCs) in de novo (DN) placement with ultrasound versus over-the-wire exchange (OTWE).Materials and MethodsData were collected retrospectively on all TDC placements at this institution from 2001 to 2019 and were excluded if no removal date was recorded or if dwell time was more than 365 days. Information on TDC brand, placement, insertion/removal, and removal reason were collected. Multiple logistic regression evaluated factors associated with TDC dislodgement. DN placement and OTWE were compared for rate of dislodgement (generalized estimating equations method) and TDC dwell time (survival analysis).ResultsIn total, 5328 TDCs were included with 66% (3522) placed DN and 32% (1727) via OTWE. Mean dwell time was 65 ± 72 days, and dislodgement occurred in 4% (224). TDC dislodgement rates in the DN and OTWE groups were 0.48 and 0.93 per 1000 catheter days, respectively. Brand (Ash Split vs. VectorFlow), placement technique (OTWE vs. DN), laterality (left vs. right), and site (left vs. right internal jugular vein) were significant predictors of dislodgement. OTWE placement exhibited 1.7 times the odds of dislodgement (95% confidence interval, 1.2–2.6; P = .004) compared to DN and had significantly higher probability of dislodgement across time (hazard ratio = 2.0; P < .001) compared to DN. Dislodgement rates for OTWE vs. DN were 8% vs. 3% (3 months), 13% vs. 6% (6 months), and 38% vs. 17% (1 year).ConclusionsTDC spontaneous dislodgement rates were significantly and consistently higher after OTWE compared to DN placement. These data support more careful attention to catheter fixation after OTWE placement. |
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