Is Tunneled Cuffed Catheter a Viable Link to AV Fistula? An Experience from a Tertiary Care Centre

Introduction: The Tunneled Cuffed Catheter (TCC) is used as a bridge access for haemodialysis. Non-availability of fluoroscopy for insertion of TCC results in unnecessary waiting times and inappropriate use of non-tunneled catheters. Recently, ultrasound guidance is being used widely in developed countries for TCC insertions for urgent haemodialysis initiation. Aim: The aim of the present study was to look at whether ultrasound guided TCC is a useful bridge to Arteriovenous Fistula (AVF) in haemodialysis patients and also to look at the incidence of catheter insertion complications, infective and bleeding complications and have data on catheter longevity. Materials and Methods: The present study was a prospective observational study. 106 TCC insertion procedures were performed between July 2017 and December 2018 in Nephrology interventional suite at St Johns MedicalCollege and Hospital, Bengaluru, Karnataka, India, using ultrasound guidance for accessing Internal Jugular Vein (IJV) by Nephrologist. Fluoroscopy was used in none. The success rate, insertion complications, infections and other catheter outcomes like bleeding, catheter blocks and catheter longevity of TCC inserted using ultrasound guidance alone were studied. Further, the patients were followed-up for a minimum period of nine months. Data was recorded in the predesigned Epi info version 7.0 proforma and analysed by SPSS software version 24. Results: There was 100% success rate for uncomplicated insertions of right IJV. No increase in major/minor bleeding complications was noted. Of the 106 insertions, only a single patient had a catheter kink. Mean blood flow was 230.3 ml/min. Cather Related Blood Stream Infecton (CRBSI) rate was 1.65 per 1000 catheter days. On follow-up, 59 of 72 patients underwent AVF creation, five underwent renal transplant and another five were converted to Continuous Ambulatory Peritoneal Dialysis (CAPD) and three patients with Acute Kidney Injury (AKI) requiring prolonged dialysis had renal recovery. Conclusion: TCCs for haemodialysis initiation can be safely placed by using ultrasound guidance. It can be used for longer period and is a useful bridge to AV fistula. There is 100% success rate for right-sided jugular TCC insertions using ultrasound alone. There are very less infective and bleeding complications with TCC usage.