From the Guidelines
Removing a tunneled dialysis catheter requires a careful, sterile approach to minimize infection risk and complications, and the procedure should be guided by the most recent and highest quality evidence, such as the 2017 study published in the Journal of the American College of Radiology 1.
Steps for Removal
The steps for removing a tunneled dialysis catheter include:
- Obtaining informed consent and explaining the procedure to the patient
- Positioning the patient supine with the head turned away from the catheter site
- Administering local anesthesia at the exit site and around the cuff
- Donning sterile gloves, mask, and gown after proper hand hygiene
- Cleaning the area with chlorhexidine or povidone-iodine solution and draping the area with sterile towels
- Removing any sutures securing the catheter using sterile scissors
- Applying gentle traction to the catheter while asking the patient to perform the Valsalva maneuver to prevent air embolism
- Making a small incision over the cuff to free it from surrounding tissue using blunt dissection, if the catheter has a cuff
- Applying steady traction to remove the catheter completely
- Immediately applying pressure to the exit site for 5-10 minutes to achieve hemostasis
- Cleaning the area again and applying a sterile occlusive dressing
- Monitoring the patient for signs of bleeding, infection, or air embolism for at least 30 minutes after the procedure
Post-Removal Care
The dressing should remain in place for 24-48 hours, and the patient should avoid strenuous activities for 24 hours. This procedure requires careful attention to sterile technique because the catheter connects directly to the central venous system, making infection prevention crucial, as highlighted in the study by Leonidou et al 1.
Indications for Removal
Catheter removal is advised if a non-tunneled CVC is suspected to be the source of S aureus bacteremia, or in the case of a tunneled device, there is evidence of a tunnel infection or ISI, as stated in the 2017 study published in the Journal of the American College of Radiology 1.
Antibiotic Treatment
Uncomplicated cases should be treated with intravenous antibiotics for a minimum of 10 to 14 days after catheter removal, and antibiotic treatment depends on sensitivities and may include penicillin, a first-generation cephalosporin, vancomycin, daptomycin, or linezolid, as recommended in the study 1.
From the Research
Steps for Removing a Tunneled Dialysis Catheter
The removal of a tunneled dialysis catheter (TDC) is a procedure that can be performed by trained nephrologists or other medical professionals. The steps involved in the removal process are not explicitly outlined in the provided studies, but the following general information can be gathered:
- The procedure can be performed in an outpatient setting or at the bedside 2, 3, 4.
- The removal of TDCs is typically performed when they are no longer needed or when there is a suspicion of infection 2, 3, 4.
- The procedure involves the physical removal of the catheter from the patient's body, which can be done with or without the use of a guide wire 5.
- Complications can occur during the removal process, including bleeding, infection, and retention of the catheter cuff 2, 3, 4.
Indications for Removal
The indications for removing a TDC include:
- Proven bacteremia or sepsis 4
- Clinical concerns for infection 4
- The catheter is no longer necessary 2, 4
- Infection or other complications associated with the catheter 6, 5
Training and Safety
The safety and success of TDC removal procedures have been evaluated in several studies:
- A study found that outpatient TDC removal by trainees was successful and safe in the vast majority of cases (99%) 2.
- Another study suggested that training general nephrologists for bedside TDC removal can afford immediate removal of infected hardware in ill patients and avoid potential delays in outpatient settings 3.
- A retrospective review of bedside TDC removals found that the procedure was well tolerated with a minimal complication rate 4.