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Tunneled Catheters

Posted By Joseph G. Abdallah, Tuesday, August 1, 2017

For catheter dependent patients: 

- Any data, guidelines or policies adopted by anyone regarding routine exchanges of TDC without an indication to prevent catheter getting stuck in central vessels/right atrium or wear of the catheter.

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Ramesh Soundararajan says...
Posted Tuesday, August 1, 2017
Not to my knowledge. Although I do remember seeing a cost analysis though stating that by exchanging prophylactically every 3 months infection and malfunctioning can be significantly decreased with cost savings. But it is not yet been validated with actual clinical data.
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Kevin C. Harned says...
Posted Tuesday, August 1, 2017
Similar to Ramesh, not to my knowledge either. I've seen so much variation on the body's reaction to a catheter, it may be hard to get a concrete answer aside from "whenever there are clinical signs of catheter dysfunction. " I've had patient's that formed fibrin sheaths in under 6 weeks, and others that went longer than 6 months. I will say I've had 2 patients with catheters greater than 18 months that were grown into the SVC on attempt at removal.
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Ryan D. Evans says...
Posted Tuesday, August 1, 2017
To be honest with you, I didn't realize that catheter attachment was such a problem. Over the past decade, I have removed hundreds of tunneled catheters, many in place for over a year. I have only ever had 1 catheter which was adhered, and that is because whoever placed it inadvertantly put the cuff into the venotomy. I don't transect the external catheter when removing it just in case it is tethered and I can't get it out. Just a safeguard.

Are others seeing this more frequently? Is it related to catheter type or positioning?
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Thierry M. POURCHEZ says...
Posted Wednesday, August 2, 2017
In France, we have permanent catheters rather for years than for months. However, we see few stuck catheters, and probably some patients are dying with it, without the knowledge of the problem.
I saw some catheters of bad material quality giving adherence in less than two years.
It was advocated about 15 years ago to exchange catheters after 3 or 5 years, to avoid this problem, but I think this is not a good idea.
In fact the real goal is to avoid permanent catheters and to place as soon as possible a functioning fistula, as distal as possible.
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Gary Saito says...
Posted Friday, August 4, 2017
Catheters will sometimes cause a stenosis which then can lead to thrombus formation around the catheter. I believe that this occurs more frequently on the left side than the right because of there are more turns and twists. The thrombus then becomes organized and very hard. The catheter then becomes attached to the organized thrombus that creates high resistance to it being pulled out. The longer length from a left sided catheter will increase the resistance. I am not aware of any studies to support routine exchange of catheters to prevent a “stuck catheter”.
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