Dr Jeffrey Wong1, Dr Tim Spicer1, Susana San Miguel1, Glenda Rayment1
1Liverpool Hospital, Sydney, Australia
Aim: Tunnelled haemodialysis catheters(TVC) are considered inferior to arteriovenous fistulae(AVF) and grafts(AVG) in centre dialysis settings. Less is known of their role in home haemodialysis(HHD) where concerns may be amplified excluding TVC patients from HHD training and require trained HHD patients to dialyse in centre during periods of permanent access dysfunction. Here we describe our experience of TVCs in the HHD setting.
Methods: Retrospective review of TVCs in HHD from 2013- 2019. Patients were identified from home therapies database. Patient details, catheter details and outcomes were obtained from electronic medical records(eMR) and letters.
Results: Twenty three TVCs were used in 21 HHD patients. Five patients commenced HHD with permanent accesses (4AVF, 1AVG) and received bridging TVCs for access malfunction at a median of 1168[IQR 612-1880] days after HHD commencement. These TVCs was used for a median of 121[IQR 49-189] days. Sixteen patients commenced HHD training with a TVC. These were used for a median of 228[IQR 130-322] days, significantly longer than the group trained with permanent access p=0.015. TVC was the intended permanent access for 1 patient which continues to function after 1941 days. Adverse outcomes include: 1 suicide by cutting TVC and 2 episodes of Staph aureus bacteraemia giving a bacteraemia rate of 0.28/1000 catheter days.
Conclusions: TVCs may be used successfully for both bridging access and for commencement of training in HHD where the duration of TVC use may be longer. In select cases where permanent access cannot be created for HHD a permanent TVC deserves consideration.
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