Management of tunneled-cuffed catheters in hemodialysis patients with hypotension and recurrent central venous thrombosis: A single-center retrospective cohort study

Objective To evaluate management strategies of tunneled-cuffed catheters (TCCs) in hemodialysis (HD) patients with hypotension and recurrent central venous thrombosis.Methods We retrospectively reviewed HD patients with hypotension treated at the West China Hospital. The initial catheter tip was positioned routinely in the superior vena cava (SVC). In the event of SVC thrombosis, stenosis, or obstruction, the catheter was adjusted to right atrial (RA) or SVC and RA junction, and then inferior vena cava (IVC). If thrombi completely dissolved, catheter tips were returned to the former section. Meanwhile, patients with central venous thrombus were treated with antiplatelet therapy. We analyzed the efficacy of the management strategy in HD with hypotension and recurrent central venous thrombosis.Results By adjusting catheter tips following the above procedure, vascular access has persevered in all the patients. Nineteen deaths (90.5%) were recorded during a median follow-up period of 6 years. No fatal pulmonary embolism nor catheter complication-related deaths were observed. The minimal survival period after the procedure was 6 years. The catheter primary patency rates at 3, 6, and 12 months were 90.5%, 66.7%, and 38.1%, respectively. The secondary patency rates were 100.0%, 80.9%, and 57.1% at 3, 6, and 12 months, respectively.Conclusion The insertion of the TCCs tips initially in SVC, then adjusting in SVC and RA junction, RA and IVC successively in the event of thrombosis combined with antiplatelet therapy may be considered effective to prolong the HD vintage in patients with hypotension.