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Despite the considerable efforts made to increase the prevalence of autogenous fistula in patients on hemodialysis, tunneled cuffed catheters are still an important access modality and used in a high percentage of the hemodialysis population. However, because of the conundrum posed by tunneled cuffed catheters, patients can develop a multitude of complications, including thrombosis, infections, formation of a fibrin sheath, and central vein stenosis, resulting in increased morbidity and mortality as well as placing a heavy burden on the healthcare system. However, with an increasing number of studies now focusing on how to manage these catheter-related complications, there has been less translational research on the pathology of these complications. This review of the most recent literature provides an update on the pathological aspects of catheter-related complications, highlighting what we need to know and what is yet to be discovered. The future research strategies and innovations needed to prevent these complications are also addressed.

Background: Catheter-related bloodstream infections (CRBSIs) are a significant cause of hospitalization and mortality among hemodialysis patients. Incidence rates and resistance patterns vary widely. Recent studies show a rise in CRBSIs caused by multidrug-resistant organisms (MDROs). This study aims to determine the incidence, microbiological profile, antibiogram and outcomes of CRBSIs in hemodialysis patients at our institution. Methods: This prospective single center observational study included all patients initiating hemodialysis with central venous double-lumen catheters. Results: During the study, 240 catheters were inserted in 240 patients. A total of 48/240 (20%) developed CRBSI with 41/48 (85.4%) having culture-positive probable CRBSI and 07/48 (14.6%) having culture-negative possible CRBSI. Concomitant exit site infection was present in 09/48 (18.8%). The CRBSI incidence rate was 1.46 episodes per 1000 catheter days, based on 48 episodes over 32,782 catheter days. The mean time to CRBSI was 204.6 ± 87.1 days. Gram-positive bacteria were cultured in 15 cases (31.3%), Gram-negative bacteria in 26 cases (54.2%), and 7 cases (14.6%) had negative culture. Coagulase negative Staphylococcus Aureus (CoNS) was the most common Gram-positive pathogens isolated, making up 46.7% of the cases. Klebsiella pneumonia, Pseudomonas, and Acinetobacter species were identified as the most prevalent Gram-negative pathogens (n = 06/26 each; 23.1%. Among 8 cultured Gram-negative bacterial species, resistance patterns observed was Ampicillin: 4/4 tested (100.0%), Quinolones: 4/6 tested (66.7%), Clotrimazole: 3/5 tested (60.0%), Carbapenems: 3/6 tested (50.0%), Gentamicin: 2/5 tested (40.0%), Amikacin: 1/3 tested (33.3%), and Piperacillin-Tazobactam: 1/5 tested (20.0%). A total of 39/48 catheters were salvaged. Conclusions: CRBSI remains a significant issue in patients using central venous catheters. The rise of multidrug-resistant Gram-negative infections necessitates stricter measures, including improved hygiene, surveillance and long-term vascular access. Proper cultures should precede empirical antibiotic therapy, and healthcare centers should tailor their antibiotic policies to local susceptibility patterns.

This study explores the feasibility, safety, and efficacy of percutaneous transluminal angioplasty (PTA) for reinserting tunneled cuffed catheters (TCC) with a Dacron sheath in the right internal jugular vein (RIJV) in hemodialysis patients with a history of prior RIJV catheterization and subsequent stenosis or occlusion of the RIJV, right innominate vein, and superior vena cava. Clinical data from 21 hemodialysis patients with dysfunctional vascular access who underwent PTA for reinsertion of TCC in the RIJVs from July 2020 to July 2023 at the First and Second Affiliated Hospitals of Bengbu Medical College were retrospectively analyzed. Clinical efficacy during hospitalization, postoperative TCC blood flow, and related complications during follow-up were observed. The procedure was successful in all 21 patients, with postoperative TCC blood flow meeting daily hemodialysis requirements. Only one case experienced acute bleeding with contrast agent extravasation at the intersection of the left and right innominate veins during sharp recanalization. No severe complications, such as arrhythmias, vascular rupture, pneumothorax, mediastinal hematoma, or pericardial tamponade, occurred during the procedures. Upon discharge, all patients exhibited satisfactory TCC blood flow (247.14 ± 11.46 ml/min). Postoperatively, TCC blood flow ranged between 200 and 260 ml/min, meeting the demands of regular hemodialysis. For patients with a history of repeated TCC or non-tunneled catheter (NTC) placement in the RIJV, reinserting TCC in the RIJVs through PTA is a safe and reliable technique. It effectively utilizes vascular resources and prevents vascular resource depletion associated with changing the venous catheter placement location.

We report here a case of allergic eczematoid dermatitis related to hemodialysis access. The patient was initially suspected to have puncture needle allergies or dialyzer reactions until the patient develops a similar response after switching from an arteriovenous fistula (AVF) to a tunneled cuffed catheter (TCC) for dialysis. Thereby, we highly suspected that the allergen was the iodine-containing disinfectant used prior to dialysis, and the patient was ultimately diagnosed with iodine-containing disinfectant allergy. The patient’s dermatitis improved remarkably after switching to alcohol disinfection as well as taking oral steroids. Early identification and diagnosis of allergic reactions at the vascular access site can avoid contacting with allergens, accordingly prevent complications like infection and loss of precious vascular accesses in these patients.

The aim of this study is to compare the patency rates of catheter placement cannulation of right external jugular vein (EJV) versus the right brachiocephalic (BCV) in patients experiencing tunneled-cuffed catheter (TCC) loss. We conducted a retrospective analysis of 30 patients admitted to our department due to TCC loss. Among them, 11 patients underwent catheter reinsertion the right EJV, while 19 patients underwent catheter reinsertion the right BCV. We collected and compared the data of these patients. In both groups of patients, there were no cases of pneumothorax, severe adjacent artery injury, or mediastinal hematoma observed. The one-year primary patency rates of the catheters in the EVJ group and the BCV group were 54.55% and 36.84%, and the primary patency rates of two years were found to be 27.27% and 21.05% respectively. There was no statistically significant difference in the patency rates at both 1 and 2 years (  = 0.55,  = 0.71). In the face of patients experiencing TCC loss, the practice of replacing dialysis catheters via the right EJV and right BCV routes emerges as a safe and efficacious alternative strategy. Notably, no difference in catheter patency rates is observed between these divergent access routes.

Catheterization methods use the lower margin of the right third intercostal space to predict the catheter tip position; however, adjustments are often necessary. We evaluated the catheter position and surface markers of the chest and the relevant factors that affect the position and depth of the catheter tip. This single-center, cross-sectional study included 173 patients who underwent right internal jugular vein tunnel insertion with a tunneled cuffed catheter (TCC). The sternal length, intercostal width, anterior-to-posterior sternal diameter, and transverse diameter of the thorax were recorded, and the thoracic aspect ratio was calculated. The cardiothoracic ratio and position of the catheter tip were measured using chest computed tomography. The correct placement was when the catheter tip was in the upper 1/3 of the right atrium (deep group: below the correct placement; shallow group: above the correct placement). Catheter tip indices were subjected to logistic regression analyses. A receiver operating characteristic (ROC) curve was used to assess the risk and optimal cutoff of the catheter tip depth. There were significant differences in sternum length, cardiothoracic ratio, anterior-to-posterior thoracic diameter, and thoracic aspect ratio between the groups (  < 0.05). The latter three variables were influencing factors for catheter tip depth (  < 0.05). The anterior-to-posterior thoracic diameter (  = 0.003; cutoff, 22.5 cm; ROC, 0.695) and thoracic aspect ratio (  = 0.014; cutoff, 0.74; ROC, 0.632) were independent risk factors for catheter tip depth and position, respectively. The position of the TCC catheter tip was related to the sternal length, anterior-to-posterior thoracic diameter, thoracic aspect ratio, and cardiothoracic ratio.

To compare the impact of tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) on outcomes in elderly hemodialysis (HD) patients. A retrospective matched cohort study was performed. Propensity score matching (PSM) was applied to balance the baseline conditions, and we compared all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCEs), hospitalization, and infection rates between AVF and TCC patients ≥70 years old. Cox survival analysis was used to analyze the risk factors for death. There were 2119 patients from our center in the Chinese National Renal Data System (CNRDS) between 1 January 2010 and 10 October 2023. Among these patients, 77 TCC patients were matched with 77 AVF patients. There was no significant difference in all-cause mortality between the TCC and AVF groups (30.1/100 33.3/100 patient-years,  = 0.124). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank  = 0.242). The TCC group had higher rates of MACCEs, hospitalization, and infection than the AVF group (33.7/100 29.5/100 patient-years, 101.2/100 79.5/100 patient-years, and 30.1/100 14.1/100 patient-years, respectively). Multivariate analysis showed that high Charlson comorbidity index (CCI) score was a risk factor for death. There was no significant difference in all-cause mortality between elderly HD patients receiving TCCs and AVFs. Compared with those with a TCC, elderly HD patients with an AVF have a lower risk of MACCEs, hospitalization, and infection.

Background Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming ‘stuck’ via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period. Case Presentation A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications. Conclusions This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.

Hemodialysis patients with end-stage renal disease (ESRD) are susceptible to infections and dysbiosis. Catheter-related infections are typically caused by opportunistic skin pathogens. This study aims to compare the skin microbiota changes around the exit site of tunneled cuffed catheters (peri-catheter group) and the contralateral site (control group). ESRD patients on hemodialysis were recruited. The skin microbiota were collected with moist skin swabs and analyzed using high-throughput sequencing of the 16S rDNA V3-V4 region. After denoising, de-replication, and removal of chimeras, the reads were assigned to zero-radius operational taxonomic units (ZOTU). We found significantly reduced alpha diversity in the peri-catheter group compared to the control group, as indicated by the Shannon, Jost, and equitability indexes, but not by the Chao1 or richness indexes. Beta diversity analysis revealed significant deviation of the peri-catheter microbiota from its corresponding control group. There was an overrepresentation of Firmicutes and an underrepresentation of Actinobacteria, Proteobacteria, and Acidobacteria at the phylum level in the peri-catheter group. The most abundant ZOTU ( spp.) drastically increased, while , a commensal bacterium, decreased in the peri-catheter group. Network analysis revealed that the skin microbiota demonstrated covariance with both local and biochemical factors. In conclusion, there was significant skin microbiota dysbiosis at the exit sites compared to the control sites in ESRD dialysis patients. Managing skin dysbiosis represents a promising target in the prevention of catheter-related bacterial infections.

Background Hemodialysis (HD) success is dependent mainly on vascular access (VA). The aim of this study is to share the experience of Pediatric Nephrology Unit (PNU), Cairo University Children’s Hospital (CUCH), with VA-related obstacles in end stage kidney disease (ESKD) HD children. Methods This is a retrospective analysis of VA related data of 187 ESKD children received regular HD over 3 year duration (2019–2021). Kaplan–Meier curves were used to present arteriovenous fistula (AVF) and cuffed catheters survivals. Results Uncuffed central venous catheter (CVC) was the primary VA for HD in up to 97.3% with 2.7% of patients had AVF performed and attained maturation before initiation of regular HD. Fifty-six (29.9%) patients have inserted 120 tunneled CVCs. AVFs & AV grafts (AVF) were performed in 79 (42.2%) and 6 (3.2%) patients respectively. There were 112 uncuffed CVCs implanted beneath the screen in Rt internal jugular vein (IJV) (44%) Lt IJV (17%), right internal mammary vein (2.7%) while Trans hepatic (TH) technique was used to place 39 uncuffed CVCs (34%) in the inferior vena cava (IVC). Catheter-related bacteremia (CRB) was the most frequent complication in uncuffed and cuffed CVCs (2.58 / 100 catheters day and 10.1 /1000 catheter days respectively). AVFs achieved a high success rate (83%) after 757.71 ± 512.3 functioning days. Conclusion Native AVF is the preferred VA for pediatric HD but its creation is limited by the small sized vessels where non-cuffed CVC could be a reasonable relatively long-term alternative. Challenging situations (occluded central veins) could benefit from TH technique of CVC insertion in IVC.