Tunneled dialysis catheter exchange through fibrin sheath crevice vs in situ catheter exchange for the treatment of catheter dysfunction

Our aim is to evaluate the safety and efficacy of tunneled dialysis catheter (TDC) exchange through fibrin sheath crevice vs in situ catheter exchange in hemodialysis patients with fibrin-sheath-related catheter dysfunction. Patients with fibrin-sheath-related catheter dysfunction who underwent TDC exchange in our center between 2012 January and 2017 December were retrospectively screened. The included patients were divided into the sheath-crevice group (catheter was exchanged through fibrin sheath crevice) and the in situ group (catheter was exchanged in situ). The blood volume, Kt/V values, and complications were assessed as outcomes. Of the 44 included patients, 25 underwent in situ catheter exchange and 19 underwent catheter exchange through the fibrin sheath crevice. The stabilized maximal blood flow during the first hemodialysis after the catheter replacement reached 250 mL/min in all of the included patients. After 3 months, the stabilized maximal blood flow of the in situ group and the sheath-crevice group were 245.3 ± 9.0 and 244.8 ± 10.05 mL/min (P = .963), respectively. However, after 6 months, the stabilized maximal blood flow during hemodialysis (P = .048) and the Kt/V value (P < .001) of the patients in the sheath-crevice group were significantly higher than the in situ group. No severe complication related to the catheter exchange surgery was observed in either group. For patients with TDC dysfunction caused by fibrin sheath, catheter exchange through the fibrin sheath crevice most likely is a safe and effective alternative strategy for in situ catheter exchange.