Clinical study
Replacement of Inadvertently Discontinued Tunneled Jugular High-flow Central Catheters with Tract Recannulation: Technical Results and Outcome

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Purpose

To determine the technical and clinical outcomes of recannulating the tracts of inadvertently discontinued high-flow tunneled internal jugular central venous catheters.

Materials and Methods

Retrospective review was performed of 49 patients who underwent 57 replacements of inadvertently discontinued catheters by recannulation from January 1997 through January 2005. The study group was divided into successful and failed recannulation groups. Technical results were evaluated for duration the catheter had been out, tract age, and laterality (ie, right vs left). Infection rate was calculated by Kaplan-Meier method and the infection rate per 100 catheter days was calculated. Intent-to-treat function rate (including failed recannulations) was calculated by the Kaplan-Meier method.

Results

Seventy percent (n = 40) of discontinued catheters were right-sided and 30% (n = 17) were left-sided. The overall technical success rate was 86% (n = 49). The technical success rates were 100% (n = 10), 89% (32 of 36), and 64% (seven of 11) for catheters that had been outside the body for less than 12 hours, 12–24 hours, and more than 24 hours, respectively. P values for successful versus failed recannulations for tract age, the time the catheter was out, and laterality were .02, .04, and .68, respectively. The infection rate for successful recannulations at 6 months was 24% ± 9% (0.22 infections per 100 catheter days). Functional catheter rates at 3, 6, 9, and 12 months were 55% ± 8%, 46% ± 8%, 29% ± 10%, and 5% ± 3%, respectively.

Conclusions

Recannulating tunneled high-flow jugular catheter tracts has a high technical success rate, particularly when they have fallen out less than 24 hours earlier and have a mature tract. The outcomes of recannulated catheters (ie, infection and function rates) are within the upper limit of results of de novo placement and over-the-wire exchange of catheters in the literature.

Section snippets

Study Design

A retrospective review of charts and radiologic studies of all patients who underwent recannulation of tracts of inadvertently discontinued tunneled jugular central catheters from January 1997 to January 2005 was performed (during a range of 8 years). A research subject review board exemption was obtained under the category of secondary use of preexisting data.

Catheter Types and Inclusion Criteria

High-flow catheters were defined as dual-lumen catheters with a collective bore of 13.5 F or greater. These included dual-lumen 14.5-F

Results

A total of 49 patients underwent 57 recannulation procedures for inadvertent discontinuation of their high-flow catheters. Twenty-five were men and 24 were women, with a mean age of 52 years (range, 19–81 y). The intended function of the high-flow catheters was hemodialysis (n = 52) or plasmapheresis (n = 5). Forty catheters were right-sided and 17 were left-sided.

Discussion

Tunneled central catheter placement is an established procedure that provides long-term venous access (1, 2, 3, 4, 5, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21). The procedural technique has evolved into a simple procedure, allowing it to move from the surgical suite to the interventional radiology suite (1, 2, 5, 9, 15, 17, 18, 21, 22). Although tunneled central catheter placement is considered a safe procedure, it does carry some risk of potential complications (1, 2, 4, 6, 7, 8, 9, 11, 12

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  • Cited by (0)

    None of the authors have identified a conflict of interest.

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