REPLACEMENT OF ACCIDENTALLY REMOVED TUNNELED VENOUS CATHETERS THROUGHEXISTING SUBCUTANEOUS TRACTS

PURPOSE: The authors describe their experience with reinsertion of acc identally removed tunnelled venous catheters using existing subcutaneo us tracts. MATERIALS AND METHODS: Replacement of 13 dislodged tunnelle d venous catheters was attempted a median of 12 hours (range, 3 hours to 5 days) after accidental removal, The catheters were needed for hem odialysis (n = 11), plasmapheresis (n = 1), or antibiotic therapy (n = 1), The tunnel exit was probed in the same fashion as for a dislodged nephrostomy tube, and new catheters were reinserted once a guide wire was advanced into the central veins, The medical record was reviewed to determine materials used and occurrence of complications, if any. R ESULTS: Replacement was successful in 12 of 13 patients, The remaining patient had a new catheter placed through a fresh puncture during the same visit, There were no infections associated with re-use of existi ng tunnels, In five patients, after probing the tract with a guide wir e, new catheters were simply advanced into the desired position, Seven other successes required additional manipulations with use of dilator s and peel-away sheaths. CONCLUSIONS: Tunnelled catheters that ''fall out'' can be readily replaced even when reinsertion is attempted up to 5 days later, This represents an important contribution that radiolog ists can offer in the management of venous access cases.