New tunneled hemodialysis catheter placement through the old exit site.

Accidental loss of tunneled hemodialysis catheters has been observed in chronic hemodialysis patients. Although a new catheter could be inserted using a fresh site, catheter insertion can also be accomplished by utilizing the existing exit site. In this analysis, we report 10 cases of an extruded tunneled hemodialysis catheter. The catheters had been in place for 2-6 months. The time elapsed after catheter extrusion ranged from 6 to 72 hours. None of the patients demonstrated any evidence of exit site or tunnel infection. Patient age ranged from 45 to 77 years. Diabetes mellitus was the cause of renal failure in 40% of the cases. Catheter insertion was accomplished by inserting a guidewire into the exit site and navigating it through the tunnel to the central venous system and into the right atrium. A diagnostic catheter was then navigated over the wire and contrast study performed to confirm the position. The wire was reinserted and a new tunneled hemodialysis catheter fed over the wire and into the atrium. Nine catheters were successfully placed using this technique. One patient had nausea and hiccups upon wire insertion into the atrium. There were no hemodynamic consequences. The wire was removed and a new catheter inserted on the other side using the left internal jugular vein. All of the catheters inserted using this technique functioned appropriately. There were no exit site or tunnel infections for up to 4 weeks' follow-up. We conclude that patients with catheter extrusion can receive a new catheter through the existing exit site, tunnel, and venotomy.