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. 2021 May:73:133-138.
doi: 10.1016/j.avsg.2021.01.059. Epub 2021 Jan 22.

Bedside Tunneled Hemodialysis Catheter Placement in Patients with COVID-19

Austin D Williams  1 , Michael Qaqish  1 , Jaafar Elnagar  1 , Lia Michos  1 , Sebastian Nantermet  1 , Robert Meisner  1 , Vincent DiGiovanni  1 , Alexander Uribe  2
Affiliations

Bedside Tunneled Hemodialysis Catheter Placement in Patients with COVID-19

Austin D Williams et al. Ann Vasc Surg. 2021 May.

Abstract

Background: COVID-19, the syndrome caused by the novel SARS-CoV2, is associated with high rates of acute kidney injury requiring renal replacement therapy (RRT). It is well known that despite the ease of bedside insertion, the use of nontunneled dialysis catheters (NTDCs) is associated with increased complications compared to tunneled dialysis catheters (TDCs). Our objective was to develop a strategy for TDC placement at the bedside to provide effective dialysis access, conserve resources and decrease personnel exposure at our medical center in an epicenter of the COVID-19 pandemic.

Methods: A technique for bedside TDC insertion with ultrasound and plain radiographs in the intensive care unit was developed. Test or clinically COVID-19-positive patients requiring RRT were evaluated for bedside emergent NTDC or nonemergent TDC placement. Patients who underwent NTDC placement were monitored for ongoing RRT needs and were converted to TDC at the bedside after 3-5 days. We prospectively collected patient data focusing on complications and mortality.

Results: Of the 36 consultations for dialysis access in COVID-positive patients from March 19 through June 5, 2020, a total of 24 bedside TDCs were placed. Only one patient developed a complication, which was pneumothorax and cardiac tamponade during line placement. In-hospital mortality in the cohort was 63.9%.

Conclusions: Bedside TDC placement has served to conserve resources, prevent complications with transport to and from the operating room, and decrease personnel exposure during the COVID-19 pandemic. This strategy warrants further consideration and could be used in critically ill patients regardless of COVID status.

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Figures

Fig 1
Fig. 1
Bedside tunneled hemodialysis catheter placement. The surgeon cannulates the internal jugular vein under ultrasound guidance (A, solid box) and confirms placement of the wire (B, arrow) and catheter (C, arrow) in the superior vena cava using plain portable radiographs (A, dotted line).
See this image and copyright information in PMC

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