A New Jersey clinician tests an approach that could decrease dialysis patients’ risk of bleeding.


WASHINGTON, D.C.—Tunneled dialysis catheters may be implanted without a sheath to limit the size of the venotomy and thus the potential for bleeding following catheter placement, according to a pilot study.

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The study showed that placing tunneled dialysis catheters without a sheath resulted in no clinically significant bleeding, according to Eyal Barzel, MD, medical director of American Access Care of New Jersey in Cherry Hill. He presented findings here at the Society of Interventional Radiology annual meeting.


He reviewed all the charts of patients in whom he had placed tunneled dialysis catheters at a single outpatient center from January 1, 2006 through September 30, 2007. Dr. Barzel said a phone call to dialysis centers to assess outcome 24 hours after catheter placement had been charted in all cases.


The investigator recorded dialysis success, evidence of infection, significant bleeding, or hospital admission for any reason. To limit percutaneous venotomy size, Dr. Barzel, at his discretion, would expand the dilator provided with the sheath, but not place the sheath. Then, he would implant the catheter directly over a stiff glidewire (Terumo) that had been placed previously in the inferior vena cava (IVC).


A total of 42 catheters were implanted (25 right internal jugular vein catheters, one right external jugular vein catheter, and 16 left internal jugular vein catheters). All the catheters were Split Cath III (Medcomp), except for one case in which a Duraflow catheter (Angiodynamics) was used. Nineteen catheters (including the Duraflow) were placed without a sheath. 


Of the 16 left internal jugular vein catheters, 13 were placed without a sheath, as were six of 25 right internal jugular vein catheters. Technical success was achieved in all 19 cases.


All catheters in both categories resulted in successful dialysis, Dr. Barzel said. No complications were recorded in any case 24 hours after placement.


One patient had a catheter removed five days after placement because it was no longer needed (she had a functioning fistula). The catheter was placed without a sheath. Dr. Barzel noted that this patient had a low-grade fever at the time of catheter removal and may have been showing early signs of infection. She was treated with antibiotics.


“There could be a potential advantage of placing a catheter without a sheath because the hole you make in the blood vessel is smaller and so you are less likely to get bleeding,” Dr. Barzel told Renal & Urology News.


“This study doesn’t prove that one method is better than another because there was no significant bleeding in the patients who had catheters with or without the sheath, although there is some logic to it that the sheathless ap-proach may be better.”