NDLI: Outpatient removal of tunneled dialysis catheters by nephrology fellows in training at a Veterans Affairs Medical Center.

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Outpatient removal of tunneled dialysis catheters by nephrology fellows in training at a Veterans Affairs Medical Center.

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Outpatient removal of tunneled dialysis catheters by nephrology fellows in training at a Veterans Affairs Medical Center.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Dossabhoy, Neville R. Sangha, Bhupinder Tapolyai, Mihály B. Fülöp, Tibor
Description	Author Affiliation: Dossabhoy NR ( Department of Medicine, Nephrology Section, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana - USA.); Sangha B ( Department of Internal Medicine, Nephrology Section, Louisiana State University Health Shreveport, School of Medicine, Shreveport, Louisiana - USA.); Tapolyai MB ( Department of Medicine, Nephrology Section, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana - USA.); Fülöp T ( Department of Internal Medicine, Nephrology Section, Louisiana State University Health Shreveport, School of Medicine, Shreveport, Louisiana - USA.)
Abstract	BACKGROUND: Removal of tunneled dialysis catheters (TDC) usually occurs in dedicated procedure suites and is performed relatively rarely at the bedside. Scarce evidence exists in the literature to assess the safety and success of this procedure when performed during supervised academic training. PATIENTS AND METHODS: We conducted a retrospective chart review of all TDC removals performed on an outpatient basis by nephrology fellows under faculty supervision during a 5-year period at an academic Veterans Affairs Medical Center. Data were collected regarding patient demographics, basic laboratory studies, pertinent clinical information and procedure-related variables. We evaluated the safety, success and complication rate of this procedure. RESULTS: We identified 72 TDC removals that met the above criteria. Mean age was 63 ± 10 years. All patients were male and hypertensive, 68% were diabetic and 69% were African-American. Overall, 88% of procedures were performed in end-stage renal disease (ESRD) patients, while the rest had needed temporary dialysis for acute kidney injury. Notably, 49 patients (68%) were taking one or more of aspirin, clopidogrel or warfarin at the time of TDC removal. Overall complication rate was low (<2%). There was no increase in risk of bleeding, even in subjects receiving anti-platelet therapy; only one of the 49 patients (2%) had a minor bleeding complication. CONCLUSIONS: Outpatient TDC removal by trainees was successful and safe in the vast majority of cases (99%). We propose that TDC removal skills should be actively pursued and acquired by all nephrology fellows. This would expand the scope of practice for future general nephrologists and facilitate timely patient care.
File Format	HTM / HTML
ISSN	11297298
Issue Number	4
Journal	The Journal of Vascular Access
Volume Number	17
e-ISSN	17246032
Language	English
Publisher	Sage Publications
Publisher Date	2016-07-12
Publisher Place	Italy
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Vascular Diseases
Content Type	Text
Resource Type	Article
Subject	Surgery Nephrology

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