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Olivier Chavanon, Jocelyne Maurizi-Balzan, Nicolas Chavanis, Bertrand Morel, Dominique Blin, Successful prolonged use of an intracardiac catheter for dialysis, Nephrology Dialysis Transplantation, Volume 14, Issue 8, August 1999, Pages 2015–2016, https://doi.org/10.1093/ndt/14.8.2015
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Extract
Vascular access for dialysis in complicated cases may be so difficult that a novel approach may be required. We report such a case of a patient with a progressive lack of central venous access.
Case
A 43-year-old patient, treated with haemodialysis since the age of 36 for chronic renal failure due to diabetes mellitus, and with a history of uraemic pericarditis for the past 3 years was followed because of progressive constrictive pericarditis. He had recurrent infection of the permanent vascular catheters due to Staphycoccus aureus chronic cutaneous infection. Staphylococcus aureus and Escherichia coli bacteriaemia frequently occurred with thrombosis of the catheters (Table 1). Each episode was treated by local and systemic antibiotherapy. The patient was hospitalized to undergo pericardectomy with simultaneous insertion of two Canaud catheters into the right atrium by sternotomy because of the total lack of venous access for dialysis (February, 1996). The superior vena cava was thrombosed and the left iliac vein access was preserved to allow for a kidney transplantation. Four months later, it was necessary to remove the Canaud catheter because of a staphylococcus infection. Dialysis was temporarily performed through a right femoral catheter which then had to be removed because of an extensive external iliac venous thrombosis. Inserting a new intra-cardiac catheter was the only alternative. After a subxiphoidal approach and a careful dissection of the right atrium, the catheter was inserted through an atrial purse-string, then fixed and tunnelled. The catheter blood flow was insufficient during dialysis, it was consequently replaced by a dual-lumen cuff catheter, through a right mini-thoracotomy. This catheter was ruptured (fatigue fracture), and had to be replaced. We inserted the new one using a guidewire inside the former. In the meantime dialysis was carried out through a left femoral access (first Shaldon, then Canaud catheter). Fifteen days later a catheter-related bacteriaemia was treated and led to removal of the catheter. The patient was dialysed through the left femoral access until the kidney transplantation which was carried out on October 4, 1998.
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