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ABSTRACT
Introduction: The Tunneled Cuffed Catheter (TCC) is used as a
bridge access for haemodialysis. Non-availability of fluoroscopy
for insertion of TCC results in unnecessary waiting times
and inappropriate use of non-tunneled catheters. Recently,
ultrasound guidance is being used widely in developed countries
for TCC insertions for urgent haemodialysis initiation.
Aim: The aim of the present study was to look at whether
ultrasound guided TCC is a useful bridge to Arteriovenous
Fistula (AVF) in haemodialysis patients and also to look at the
incidence of catheter insertion complications, infective and
bleeding complications and have data on catheter longevity.
Materials and Methods: The present study was a prospective
observational study. 106 TCC insertion procedures were
performed between July 2017 and December 2018 in
Nephrology interventional suite at St Johns MedicalCollege
and Hospital, Bengaluru, Karnataka, India, using ultrasound
guidance for accessing Internal Jugular Vein (IJV) by
Nephrologist. Fluoroscopy was used in none. The success
rate, insertion complications, infections and other catheter
outcomes like bleeding, catheter blocks and catheter
longevity of TCC inserted using ultrasound guidance alone
were studied. Further, the patients were followed-up for a
minimum period of nine months. Data was recorded in the
predesigned Epi info version 7.0 proforma and analysed by
SPSS software version 24.
Results: There was 100% success rate for uncomplicated
insertions of right IJV. No increase in major/minor bleeding
complications was noted. Of the 106 insertions, only a single
patient had a catheter kink. Mean blood flow was 230.3 ml/min.
Cather Related Blood Stream Infecton (CRBSI) rate was 1.65 per
1000 catheter days. On follow-up, 59 of 72 patients underwent
AVF creation, five underwent renal transplant and another five
were converted to Continuous Ambulatory Peritoneal Dialysis
(CAPD) and three patients with Acute Kidney Injury (AKI)
requiring prolonged dialysis had renal recovery.
Conclusion: TCCs for haemodialysis initiation can be safely
placed by using ultrasound guidance. It can be used for longer
period and is a useful bridge to AV fistula. There is 100% success
rate for right-sided jugular TCC insertions using ultrasound
alone. There are very less infective and bleeding complications
with TCC usage