Insertion of Tunneled Hemodialysis Catheters by Exchange over the Guidewire and De Novo Puncture

Abstract

Background: This study evaluated the safety and efficacy of insertion of tunneled hemodialysis catheters by de novo insertion technique and over the wire exchange technique Methods: This prospective study included 50 patients with ERSD in need for tunneled hemodialysis catheters insertion. Patients were divided into 2 groups (the first group) 22 de novo insertion of tunneled dialysis catheters and (the second group) 28 over the wire exchange. Patients were subjected to history taking, thorough clinical examination, routine preoperative investigations, preoperative and postoperative X-ray on the neck and chest and Duplex scan of neck veins on both sides. Results: In the de novo group, 11 patients were inserted by ultrasound guide and 11 patients were inserted by blind anatomical landmark technique in which the ultrasound guided technique showed lower rate of complications, while all over the wire group were inserted ultrasound guided. The primary patency was higher in the over the wire group(after 1 month=96%, after 3 months=89.2%, after 3 months=85.7%) than the de novo group(after 1m, 3m, 6m equals 86.3%,81.8%, 77.2% respectively) with non-significant P value 0.43, hematoma formation was higher in the de novo group with non-significant P value, 3 patients  (13.6%) had infected catheters in the de novo group while 4 (14.3%) patients were affected in over the wire group, with 4 (18.2%) cases were malfunctioning in the de novo group while 3 (10.7) malfunctioning catheters in over the wire group with statistically non-significant P value in these values.  There was significant difference between the 2 techniques in the operative time, for de novo insertion of tunneled dialysis catheters mean operative time was = 27.78 ± 5.71 minutes and in over the wire group the mean operative time was = 15.07 ± 1.98 minutes with statistically significant P value <0.001*. Conclusions: By comparison between the two methods of tunneled dialysis catheters insertion in ESRD patients (de novo insertion and over the wire exchange technique), we found that over the wire exchange technique can safe time, effort, reduce the rate of operative complication especially hematoma formation and at the same time it showed higher patency rate in comparison to de novo insertion method.