Successful Removal and Replacement of a Stuck Hemodialysis Catheter via Thoracotomy: Report of Two Cases and Literature Review

IF 0.7 Q4 UROLOGY & NEPHROLOGY Case Reports in Nephrology and Dialysis Pub Date : 2024-04-03 DOI:10.1159/000537740
Yanqin Fan, Dejiao He, Jing Cheng, Zhenzhong Wu, Yiqun Hao, Hongyan Liu
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Abstract

Abstract Introduction Stuck tunneled central venous catheters (CVCs) have been increasingly reported. In rare cases, the impossibility of extracting the CVC from the central vein after regular traction is the result of rigid adhesions to the surrounding fibrin sheath. Forced traction during catheter removal can cause serious complications, including cardiac tamponade, hemothorax, and hemorrhagic shock. Knowledge and experience on how to properly manage the stuck catheter are still limited. Case Presentation Here, we present two cases that highlight the successful removal of the stuck tunneled CVC via thoracotomy through the close collaboration of multidisciplinary specialists in the best possible way. Both patients underwent an unsuccessful attempt at thrombolytic therapy with urokinase, catheter traction under the guidance of digital subtraction angiography and intraluminal balloon dilation. And we reviewed the literature on stuck catheters in the hope of providing knowledge and effective approaches to attempted removal of stuck catheters. Conclusion There is no standardized procedure for dealing with stuck catheters. Intraluminal percutaneous transluminal angioplasty should be considered as the first-line treatment, while open surgery represents a second option only in the event of failure. Care must be taken that forced extubation can cause patients life-threatening.
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通过胸廓切开术成功取出并更换卡住的血液透析导管:两例病例报告和文献综述
摘要 引言 隧道式中心静脉导管(CVC)被卡住的报道越来越多。在极少数病例中,由于周围纤维蛋白鞘硬性粘连,在常规牵引后仍无法将 CVC 从中心静脉中拔出。在移除导管时强行牵引可能会引起严重的并发症,包括心脏填塞、血胸和失血性休克。关于如何正确处理卡住的导管的知识和经验仍然有限。病例介绍 在此,我们介绍两例通过多学科专家的密切合作,以最佳方式成功通过开胸手术取出卡住的隧道式 CVC 的病例。这两名患者都接受了尿激酶溶栓治疗,在数字减影血管造影术和腔内球囊扩张术的指导下进行了导管牵引,但均未成功。我们回顾了有关卡住导管的文献,希望能为尝试移除卡住的导管提供知识和有效方法。结论 目前还没有处理卡住导管的标准化程序。腔内经皮穿刺血管成形术应被视为第一线治疗方法,而开放手术仅在失败的情况下作为第二选择。必须注意的是,强行拔管可能会危及患者生命。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.20
自引率
0.00%
发文量
36
审稿时长
10 weeks
期刊介绍: This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of nephrology and dialysis, including genetic susceptibility, clinical presentation, diagnosis, treatment or prevention, toxicities of therapy, critical care, supportive care, quality-of-life and survival issues. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed.
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