Thread by @aishaikh

💥 A ‘Stuck’ Hemodialysis Catheter
- A Tweetorial

⚡️What is a ‘Stuck’ HD catheter?
⚡️What are the risk factors?
⚡️How to manage it?

@ASDINNews
#VascualarAccessPearls

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💥What is a ‘Stuck’ Hemodialysis Catheter?

⚡️Commonly referred to as a ‘Hemodialysis catheter that won’t come out’

But there is more to it...

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💥A ‘Stuck’ or ‘Tethered’ Tunneled HD CVC is a catheter that cannot be removed after dissection & release of the catheter cuff

⚡️It likely occurs due to fibrin sheath formation around the CVC & subsequent adherence of the sheath to the vessel wall

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💥Here is a video of a ‘Hemodialysis catheter cuff dissection & catheter removal’👇🏽



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💥As seen in the video above, the HD catheter can easily be removed after cuff dissection, & only gentle traction is needed to remove the CVC

⚡️If the CVC remains stuck despite cuff dissection then cutdown over the CVC near the neck can be done

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💥Time for a poll question:

If the HD catheter remains stuck despite cuff dissection & cutdown then the next best step to remove the stuck HD catheter is:
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💥If the catheter remains ‘stuck’ following the cuff dissection & following the cutdown maneuver then forceful traction to remove the CVC must be avoided as it can lead to complications

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💥Complications associated with forceful traction of the HD catheter include:

⚡️Severe pain
⚡️Avulsion of the great vessels
⚡️Damage to the tricuspid valve
⚡️Catheter fracture

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💥How often does one encounter a ‘stuck’ HD catheter?

⚡️It is rare & the incidence is ~1%
👉🏽pubmed.ncbi.nlm.nih.gov/25953209/

⚡️But because CVC use is very common, you are very likely to encounter this problem in your clinical practice

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💥What are the risk factors that lead to a ‘stuck’ HD catheter?

⚡️Cumulative duration of CVC use (>1 year) appears to ⬆️ the risk of catheter adhesion

⚡️This is why some have suggested annual prophylactic CVC exchange (‼️This is not done in practice)

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💥A Stuck HD catheter
Other potential risk factors include:

⚡️Female gender
⚡️Composition of the CVC
⚡️LIJ CVC
⚡️Prior CVC stenosis

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💥So what can be done to remove a stuck HD catheter?

⚡️In 2011, Hong et al described the endoluminal ballon dilatation technique to remove a stuck HD CVC

👉🏽 pubmed.ncbi.nlm.nih.gov/21688240/

⚡️Subsequent reports have confirmed success with this technique

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💥What is the Endoluminal balloon dilatation technique?

⚡️A balloon is inserted into the HD catheter thru the venous lumen of the CVC & then the balloon is inflated along the length of the CVC from the tip to the cuff of the CVC

⚡️See images👇🏽

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💥The Endoluminal balloon dilatation technique likely disrupts the
peri-catheter adhesions facilitating the catheter removal

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💥In this case-control study of 15 patients with a stuck HD catheter, no complications were observed with the endoluminal balloon dilatation technique

👉🏽 ncbi.nlm.nih.gov/pmc/articles/P…

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💥Other more invasive interventional techniques used for removal of a stuck HD catheters are:

⚡️Removal of the CVC hub & use of a vascular sheath around the CVC for extraction
⚡️Use of snares for extraction
⚡️Median Sternotomy & Thoracotomy

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💥In some cases, a conservative approach is taken where the stuck HD catheter is left behind ‘embedded’ or ‘buried’, but this approach can lead to serious complications such as:

⚡️Infection
⚡️Thromboembolism
⚡️Chronic pain

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💥Let’s take the poll again:

If the HD catheter remains stuck despite cuff dissection & cutdown, then the next best step to remove the stuck HD catheter is:

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💥Summary

⚡️Stuck HD catheters are rare but can be seen w/ prolonged CVC use

⚡️If CVC cuff dissection & cutdown fail in removing the HD catheter then endoluminal balloon dilatation is the preferred intervention for removal of a ‘stuck’ HD catheter

End/