Permanent Catheters Aren't (Practice Corner‪)‬

An insidious word has found its way into the nephrology vocabulary, bringing with it an erroneous notion. That word is "perm-cath". To patients, nurses and doctors alike, the concept of a permanent central venous catheter for hemodialysis is appealing. For patients, these catheters are virtually pain-free after the initial insertion, and for hemodialysis nurses, they are easy to use, often saving time and the inconvenience of needling. We are well aware of the usual complications of external vascular accesses--namely infection, bacteremia, thrombosis (clotting), flow problems (placement), accidental dislodging or cutting, kinking, central venous stenosis, and accidental air emboli, to name a few. Allow me to add a new complication to that list: catheter retention. In the Division of Nephrology at the University Health Network (UHN) in Toronto, Ontario, we have developed a program in which, as the Nephrology Nurse Practitioner (NP), I have been educated by interventional radiologists to remove tunnelled, cuffed hemodialysis catheters. I now carry out the majority of removals and am responsible for teaching the skill to nephrology medical trainees. This program has been operating successfully for the past 15 years, and has allowed for development of expertise in this skill. As UHN is a centre of excellence in renal transplantation and hemodialysis, there is a significant need for access to expedited tunnelled line removal. Approximately 100 catheters per year are ordered for removal at UHN. Therefore, it is estimated that I have carried out this procedure more than 1,500 times over the past 15 years--and have, unfortunately, seen many of the complications that can arise during this procedure.