The use of a tunneled permanent catheter as temporary vascular access in arteriovenous graft patients for long-term patency

Abstract

Background

Generally, the preferred route of vascular access in chronic kidney disease patients is an arteriovenous fistula (AVF) rather than grafts. However, approximately 7% of 300,000 Japanese hemodialysis (HD) patients continue to dialyze with grafts. In patients who have arteriovenous grafts (AVGs), complications such as thrombosis, hemorrhaging, and infection are common, resulting in lower graft patency. Therefore, in our hospital, to improve graft patency, cases requiring HD immediately after AVG surgery (vascular access occlusion) undergo placement of a tunneled (cuffed) permanent catheter in the internal jugular vein at the time of AVG creation to eliminate preemptive interventions in grafts at risk for thrombosis, hematoma, and infection. We use a tunneled permanent catheter instead of a nontunneled (noncuffed) temporary catheter because nontunneled temporary catheters often require replacement due to catheter-related bacteremia and thrombotic occlusion before the first cannulation.

Case presentation

Here, we present four conventional HD patients who had vascular access occlusion and required HD immediately after AVG surgery. The patients underwent placement of a tunneled permanent catheter for temporary vascular access in AVG creation. Once edema in the access arm had completely improved, the first cannulation and then catheter removal were performed.

Conclusions

In conclusion, while the duration between AVG creation and its first use on HD has been prolonged, graft patency has been good. Although additional cases are required to confirm the efficacy of this approach, this finding enables the dialysis community to consider the initiation of AVG use immediately in cases of vascular access occlusion.