Dr. Shankar Kumar Chatterjee - A Single Centre Experience Of 284 Tunneled Chronic Venous Haemodialysis Catheter Insertions

1. Shankar Kumar Chatterjee, Rohit Rungta, Santosh Kumar,
Deepak Kumar, Sushma Bala,
Sharmila Thukral, Biplab Ghosh,
Pratik Das & Deepak Shankar Ray.

2. AIMS
 Study the long term outcome of pts using TVCs as a long term access.
 Compare the outcomes according to sites of insertions.
MATERIALS & METHODS
 Single centre audit of 264 insertions done between January 1, 2012 and March
30, 2016
 OT insertions under local anaesthesia by percutaneous technique under
fluoroscopic guidance.
 Pts who had been followed up for a minimum period of 3 months were included
in this study. Out of 264 1 failed due to obstruction in all veins. 17 out of 264
were lost to follow up.
 Results were analyzed in 246 cases as 18 pts were not included in the outcome
analysis.

3.  142 (58 %) males and 104(42 %) females.
 The mean age 54.95 years with std deviation of 14.31.
 RIJV -149 (60.5%)
 LIJV.-83(33.7%)
 LSCV-5 (2.03 %)
 RSCV-2 (0.81 %)
 LFV-3 (1.21 %)
 RFV-3 (1.21%)
 TRANSLUMBAR VEIN- 1(0.004%)
 Repositioning- 5 (2.03%).
Sex M
142(58
%)
F
104(42
%)
Sites of insertion
RIJV 149(60.5%)
LIJV 83(33.7%)
LSCV 5(2.03%)
RCSV 2(0.81%)
LFV 3(1.21%)

4.  Immediate Complications
 Procedural blood loss 1.13%
(3/264)
 Capillary oozing 1.89%% (5/264)
 Catheter Kinking 1.13% (3/264)
 No major intra-operative
complications ( 1 pt had GTCS)
 Long term Complications
 Catheter Block
▪ intraluminal thrombus/fibrin
sleeve 4.11% (7/170)
 Catheter related bacteraemia
34.70% (59/170)
 Catheter dislodgement 1.17%
(2/170)
 SVC stenosis. 1.76% (3/170)
 average flow rate- 302.23 ml/min
 average catheter survival - 247.9 days
 longest functioning catheter- 665 days
 3 month catheter survival- 91.04% %
 6 month catheter survival – 61.19 %
 1 year survival - 32.83 %
 Causes of catheter removal
 Patients expired with functioning
catheters -23.17%
 Infection - 22.76 %
 AV fistula maturing -21.11%
 renal transplant - 18.29 %
 Spontaneous dislodgement 0.40%
 Catheter block -2.43 %
 Removal of catheter due to infection the
lower body was 1 out of 7 (14.28%)
against an upper 55 out of 239 (23.01%)

7.  Tunneled Chronic Venous Catheters - a viable mode
of vascular access for haemodialysis.
 Complication rates are low.
 Catheter infection rates are an area of concern.
 Lower body catheter insertions (Femoral &
Translumbar) do not appear to be inferior to that of
upper body insertions (Internal Jugular and
Subclavian).