Research progress on tunnel-cuffed catheter placement and maintenance in maintenance hemodialysis patients_West China Medical Journal

Authors：

CHE Xu ¹ ,  QIAO Dongge ² , GUO Cunxia ³ , CAO Qizheng ⁴ , CUI Rongrong ⁴

1. Nursing Department, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan 450002, P. R. China;
2. The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450001, P. R. China;
3. Blood Purification Center, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan 450002, P. R. China;
4. School of Nursing, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, P. R. China;

Corresponding?author：

QIAO Dongge, Email: 906926832@qq.com

Keywords：

Hemodialysis; tunnel-cuffed catheter; research progress; review

DOI：

10.7507/1002-0179.202210194

Video：

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Abstract Full text Figures/Tables Video References Cited by

Tunnel-cuffed catheter catheters are one of the important means of vascular access for hemodialysis patients. Appropriate catheter placement methods and effective intervention measures can help improve the service life of tunnel catheters, reduce the incidence of complications, and ensure the quality of dialysis treatment. This article provides a review of the placement and maintenance of tunnel-cuffed catheters, with the aim of providing a reference for medical staff to perform tunnel-cuffed catheterization operations and reduce related complications. The placement of tunnel-cuffed catheters includes the type, location, and tip positioning of the catheter, the maintenance includes endovascular monitoring and use of disinfectants, dressings and ointments, use of sealing fluid, management of catheter complications, identification of individual differences and early assessment and screening.

Citation： CHE Xu, QIAO Dongge, GUO Cunxia, CAO Qizheng, CUI Rongrong. Research progress on tunnel-cuffed catheter placement and maintenance in maintenance hemodialysis patients. West China Medical Journal, 2023, 38(7): 1077-1081. doi: 10.7507/1002-0179.202210194 Copy

1.	中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識(第 2 版). 中國血液凈化, 2019, 18(6): 365-381.
2.	李玉偉, 王海蛟, 崔巍, 等. 保留后方韌帶復合體的腰椎融合術遠期療效觀察. 中國修復重建外科雜志, 2019, 33(1): 56-60.
3.	Agarwal AK, Haddad N, Boubes K. Avoiding problems in tunneled dialysis catheter placement. Semin Dial, 2019, 32(6): 535-540.
4.	王慧, 姚苗苗, 張佳馨, 等. 血液透析患者中心靜脈置管護理的最佳證據總結. 中國血液凈化, 2020, 19(8): 569-572.
5.	熊嫚, 賀銳, 趙曉珊, 等. 血液透析患者中心靜脈置管后導管相關性血栓研究進展. 成都醫學院學報, 2022, 17(3): 395-399.
6.	楊陽, 張凌, 劉晨, 等. 血液凈化中心靜脈導管結構優化的研究進展. 生物醫學工程研究, 2022, 41(4): 411-416.
7.	劉云訪, 喻姣花, 黃海燕, 等. ICU 中心靜脈導管相關性血流感染預防的證據總結. 護士進修雜志, 2020, 35(4): 319-325, 333.
8.	張葉, 陳嘉, 徐寧, 等. 中心靜脈導管相關血流感染的預防新進展. 中國老年保健醫學, 2019, 17(5): 103-105.
9.	Clark E, Kappel J, MacRae J, et al. Practical aspects of nontunneled and tunneled hemodialysis catheters. Can J Kidney Health Dis, 2016, 3: 2054358116669128.
10.	Leiderman DBD, Souza KP, Binatti CET, et al. Arm mobilization provokes deformity of long-term indwelling ports implanted via the jugular vein. J Vasc Surg Venous Lymphat Disord, 2021, 9(4): 998-1006.
11.	Ling XC, Lu HP, Loh EW, et al. A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters. J Vasc Surg, 2019, 69(4): 1282-1292.
12.	Letachowicz K, Go??biowski T, Mi? M, et al. Partial breakage of a tunneled dialysis catheter: an uncommon finding. Hemodial Int, 2021, 25(2): E15-E17.
13.	Zhai S, Zhao Q, Feng Y, et al. Placement of tunneled cuffed vascular catheter through superior vena cava puncture. J Vasc Surg Venous Lymphat Disord, 2017, 5(4): 547-552.
14.	侯西彬, 楊濤, 詹申, 等. 四點定位法確定左側頸內靜脈隧道式 Cuff 導管皮下隧道長度. 臨床腎臟病雜志, 2018, 18(9): 571-573.
15.	NKF-K/DOQI. III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis, 2001, 37(Suppl 1): S137-S181.
16.	da Hora Passos R, Ribeiro M, Neves J, et al. Agitated saline bubble-enhanced ultrasound for assessing appropriate position of hemodialysis central venous catheter in critically ill patients. Kidney Int Rep, 2017, 2(5): 952-956.
17.	武煜, 王玲, 朱仁明, 等. 超聲結合數字減影血管造影引導下頸內靜脈置管的臨床應用. 轉化醫學電子雜志, 2016, 3(12): 11-13.
18.	韓世盛, 徐艷秋, 王怡. 采用胸部 CT 定位頸部隧道式血液透析導管尖端位置. 中國血液凈化, 2021, 20(9): 635-636.
19.	汪麗平, 魯琦, 張海玲, 等. 生理鹽水導引腔內心電圖技術在新生兒臍靜脈置管定位中的應用. 護理學雜志, 2021, 36(11): 1-3.
20.	Bream PR, Gu E. Use of an ECG-based confirmatory technique for bedside placement of reverse-tunneled cuffed dialysis catheters in three morbidly obese patients. Kidney Int, 2015, 88(3): 633-636.
21.	王雅雯, 仇曉霞. 腔內心電圖定位技術輔助中心靜脈通路導管尖端定位的研究進展. 護士進修雜志, 2022, 37(1): 52-56.
22.	Cho S, Lee YJ, Kim SR. The intracavitary ECG method for insertion of a tunneled dialysis catheter without using fluoroscopy. J Vasc Access, 2015, 16(4): 285-288.
23.	Ohara T, Sakurama K, Hiramatsu S, et al. New insertion support device assisted the accurate placement of tunneled cuffed catheter: first experience of 10 cases. J Vasc Access, 2018, 19(5): 501-505.
24.	Weber E, Liberek T, Wo?yniec W, et al. Catheter tip malposition after percutaneous placement of tunneled hemodialysis catheters. Hemodial Int, 2015, 19(4): 509-513.
25.	Kang JS, Jang HR, Lee JE, et al. The bacterial colonization in tunneled cuffed dialysis catheter and its effects on residual renal function in incident hemodialysis patients. Clin Exp Nephrol, 2016, 20(2): 294-301.
26.	Bra?as P, Morales E, Ríos F, et al. Usefulness of endoluminal catheter colonization surveillance cultures to reduce catheter-related bloodstream infections in hemodialysis. Am J Infect Control, 2014, 42(11): 1182-1187.
27.	Landry DL, Jaber RA, Hanumanthappa N, et al. Effects of prolonged ethanol lock exposure to carbothane- and silicone-based hemodialysis catheters: a 26-week study. J Vasc Access, 2015, 16(5): 367-371.
28.	劉宏, 孫曉萌, 張留平, 等. 70%乙醇封管在血液透析帶隧道帶滌綸套導管中的應用. 第二軍醫大學學報, 2017, 38(3): 329-334.
29.	秦鐘媚, 吳春霞, 張麗宏. 改良皮膚管理對帶 Cuff 血透導管置管者感染預防的效果. 上海護理, 2020, 20(3): 51-54.
30.	姜艷華, 邢唯杰, 周興梅, 等. 連續性腎臟替代治療患者中心靜脈導管維護的最佳證據總結. 護士進修雜志, 2021, 36(6): 533-539.
31.	游暢, 廖宇捷, 楊紅, 等. 敷料改良包扎法在血透 cuff 導管護理中的應用. 中國醫藥科學, 2018, 8(2): 93-96.
32.	謝素珍, 吳凌如, 周雅虹. 改良導管維護方式在血液透析患者 cuff 導管護理中的應用. 透析與人工器官, 2021, 32(3): 56-57, 59.
33.	吳春霞, 羅淑媛, 張麗宏, 等. 兩種不同置管口護理方法對預防帶 cuff 血透導管感染的影響. 實用臨床護理學電子雜志, 2020, 5(4): 128.
34.	鄭茜茜, 梅曉蓉, 黃若, 等. 血液透析隧道式深靜脈導管出口自我護理效果探討. 護士進修雜志, 2018, 33(11): 1048-1050.
35.	朱影, 陳林, 刁永書. 帶 Cuff 的雙腔中心靜脈留置導管在血液透析中的護理. 西部醫學, 2011, 23(11): 2261-2262.
36.	Ponce D, Mendes M, Silva T, et al. Occluded tunneled venous catheter in hemodialysis patients: risk factors and efficacy of alteplase. Artif Organs, 2015, 39(9): 741-747.
37.	Winnicki W, Herkner H, Lorenz M, et al. Taurolidine-based catheter lock regimen significantly reduces overall costs, infection, and dysfunction rates of tunneled hemodialysis catheters. Kidney Int, 2018, 93(3): 753-760.
38.	梁曉倩, 楊爽, 張放, 等. MHD 患者應用枸櫞酸鈉和肝素鈉對 Cuff 導管維持開放的效果. 河北醫藥, 2019, 41(21): 3253-3256.
39.	Oguzhan N, Pala C, Sipahioglu MH, et al. Locking tunneled hemodialysis catheters with hypertonic saline (26% NaCl) and heparin to prevent catheter-related bloodstream infections and thrombosis: a randomized, prospective trial. Ren Fail, 2012, 34(2): 181-188.
40.	Zhao T, Liu H, Han J. Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis. Int Urol Nephrol, 2018, 50(9): 1643-1652.
41.	Schilcher G, Schlagenhauf A, Schneditz D, et al. Ethanol causes protein precipitation--new safety issues for catheter locking techniques. PLoS One, 2013, 8(12): e84869.
42.	Tasca Okamoto GF, Oliveira Portela FS, Alexandrino da Silva MF, et al. Intraoperative evaluation of tunneled dialysis catheter mobility and function with arm movement. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 146-151.
43.	吳健誼, 賈中尉, 楊林. 帶 cuff 的中心靜脈導管接頭破損原因分析及護理對策. 護理學雜志, 2019, 34(15): 50-51.
44.	Parvulescu F, Oliver MJ, Reyna ME, et al. Factors affecting cuff extrusion of tunneled hemodialysis catheters. Can Assoc Radiol J, 2022, 73(2): 410-418.
45.	朱幼平, 袁慧中. 維持性血液透析患者帶 Cuff 的中心靜脈導管移位的原因及預防. 鄂州大學學報, 2016, 23(5): 110-112.
46.	鄢成靜, 于洋, 周莉, 等. Caprini 靜脈血栓風險評估模型在隧道式 cuff 透析導管功能不良伴中心靜脈血栓患者中的有效性. 中華腎臟病雜志, 2017, 33(6): 429-434.

1. 中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識(第 2 版). 中國血液凈化, 2019, 18(6): 365-381.
2. 李玉偉, 王海蛟, 崔巍, 等. 保留后方韌帶復合體的腰椎融合術遠期療效觀察. 中國修復重建外科雜志, 2019, 33(1): 56-60.
3. Agarwal AK, Haddad N, Boubes K. Avoiding problems in tunneled dialysis catheter placement. Semin Dial, 2019, 32(6): 535-540.
4. 王慧, 姚苗苗, 張佳馨, 等. 血液透析患者中心靜脈置管護理的最佳證據總結. 中國血液凈化, 2020, 19(8): 569-572.
5. 熊嫚, 賀銳, 趙曉珊, 等. 血液透析患者中心靜脈置管后導管相關性血栓研究進展. 成都醫學院學報, 2022, 17(3): 395-399.
6. 楊陽, 張凌, 劉晨, 等. 血液凈化中心靜脈導管結構優化的研究進展. 生物醫學工程研究, 2022, 41(4): 411-416.
7. 劉云訪, 喻姣花, 黃海燕, 等. ICU 中心靜脈導管相關性血流感染預防的證據總結. 護士進修雜志, 2020, 35(4): 319-325, 333.
8. 張葉, 陳嘉, 徐寧, 等. 中心靜脈導管相關血流感染的預防新進展. 中國老年保健醫學, 2019, 17(5): 103-105.
9. Clark E, Kappel J, MacRae J, et al. Practical aspects of nontunneled and tunneled hemodialysis catheters. Can J Kidney Health Dis, 2016, 3: 2054358116669128.
10. Leiderman DBD, Souza KP, Binatti CET, et al. Arm mobilization provokes deformity of long-term indwelling ports implanted via the jugular vein. J Vasc Surg Venous Lymphat Disord, 2021, 9(4): 998-1006.
11. Ling XC, Lu HP, Loh EW, et al. A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters. J Vasc Surg, 2019, 69(4): 1282-1292.
12. Letachowicz K, Go??biowski T, Mi? M, et al. Partial breakage of a tunneled dialysis catheter: an uncommon finding. Hemodial Int, 2021, 25(2): E15-E17.
13. Zhai S, Zhao Q, Feng Y, et al. Placement of tunneled cuffed vascular catheter through superior vena cava puncture. J Vasc Surg Venous Lymphat Disord, 2017, 5(4): 547-552.
14. 侯西彬, 楊濤, 詹申, 等. 四點定位法確定左側頸內靜脈隧道式 Cuff 導管皮下隧道長度. 臨床腎臟病雜志, 2018, 18(9): 571-573.
15. NKF-K/DOQI. III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis, 2001, 37(Suppl 1): S137-S181.
16. da Hora Passos R, Ribeiro M, Neves J, et al. Agitated saline bubble-enhanced ultrasound for assessing appropriate position of hemodialysis central venous catheter in critically ill patients. Kidney Int Rep, 2017, 2(5): 952-956.
17. 武煜, 王玲, 朱仁明, 等. 超聲結合數字減影血管造影引導下頸內靜脈置管的臨床應用. 轉化醫學電子雜志, 2016, 3(12): 11-13.
18. 韓世盛, 徐艷秋, 王怡. 采用胸部 CT 定位頸部隧道式血液透析導管尖端位置. 中國血液凈化, 2021, 20(9): 635-636.
19. 汪麗平, 魯琦, 張海玲, 等. 生理鹽水導引腔內心電圖技術在新生兒臍靜脈置管定位中的應用. 護理學雜志, 2021, 36(11): 1-3.
20. Bream PR, Gu E. Use of an ECG-based confirmatory technique for bedside placement of reverse-tunneled cuffed dialysis catheters in three morbidly obese patients. Kidney Int, 2015, 88(3): 633-636.
21. 王雅雯, 仇曉霞. 腔內心電圖定位技術輔助中心靜脈通路導管尖端定位的研究進展. 護士進修雜志, 2022, 37(1): 52-56.
22. Cho S, Lee YJ, Kim SR. The intracavitary ECG method for insertion of a tunneled dialysis catheter without using fluoroscopy. J Vasc Access, 2015, 16(4): 285-288.
23. Ohara T, Sakurama K, Hiramatsu S, et al. New insertion support device assisted the accurate placement of tunneled cuffed catheter: first experience of 10 cases. J Vasc Access, 2018, 19(5): 501-505.
24. Weber E, Liberek T, Wo?yniec W, et al. Catheter tip malposition after percutaneous placement of tunneled hemodialysis catheters. Hemodial Int, 2015, 19(4): 509-513.
25. Kang JS, Jang HR, Lee JE, et al. The bacterial colonization in tunneled cuffed dialysis catheter and its effects on residual renal function in incident hemodialysis patients. Clin Exp Nephrol, 2016, 20(2): 294-301.
26. Bra?as P, Morales E, Ríos F, et al. Usefulness of endoluminal catheter colonization surveillance cultures to reduce catheter-related bloodstream infections in hemodialysis. Am J Infect Control, 2014, 42(11): 1182-1187.
27. Landry DL, Jaber RA, Hanumanthappa N, et al. Effects of prolonged ethanol lock exposure to carbothane- and silicone-based hemodialysis catheters: a 26-week study. J Vasc Access, 2015, 16(5): 367-371.
28. 劉宏, 孫曉萌, 張留平, 等. 70%乙醇封管在血液透析帶隧道帶滌綸套導管中的應用. 第二軍醫大學學報, 2017, 38(3): 329-334.
29. 秦鐘媚, 吳春霞, 張麗宏. 改良皮膚管理對帶 Cuff 血透導管置管者感染預防的效果. 上海護理, 2020, 20(3): 51-54.
30. 姜艷華, 邢唯杰, 周興梅, 等. 連續性腎臟替代治療患者中心靜脈導管維護的最佳證據總結. 護士進修雜志, 2021, 36(6): 533-539.
31. 游暢, 廖宇捷, 楊紅, 等. 敷料改良包扎法在血透 cuff 導管護理中的應用. 中國醫藥科學, 2018, 8(2): 93-96.
32. 謝素珍, 吳凌如, 周雅虹. 改良導管維護方式在血液透析患者 cuff 導管護理中的應用. 透析與人工器官, 2021, 32(3): 56-57, 59.
33. 吳春霞, 羅淑媛, 張麗宏, 等. 兩種不同置管口護理方法對預防帶 cuff 血透導管感染的影響. 實用臨床護理學電子雜志, 2020, 5(4): 128.
34. 鄭茜茜, 梅曉蓉, 黃若, 等. 血液透析隧道式深靜脈導管出口自我護理效果探討. 護士進修雜志, 2018, 33(11): 1048-1050.
35. 朱影, 陳林, 刁永書. 帶 Cuff 的雙腔中心靜脈留置導管在血液透析中的護理. 西部醫學, 2011, 23(11): 2261-2262.
36. Ponce D, Mendes M, Silva T, et al. Occluded tunneled venous catheter in hemodialysis patients: risk factors and efficacy of alteplase. Artif Organs, 2015, 39(9): 741-747.
37. Winnicki W, Herkner H, Lorenz M, et al. Taurolidine-based catheter lock regimen significantly reduces overall costs, infection, and dysfunction rates of tunneled hemodialysis catheters. Kidney Int, 2018, 93(3): 753-760.
38. 梁曉倩, 楊爽, 張放, 等. MHD 患者應用枸櫞酸鈉和肝素鈉對 Cuff 導管維持開放的效果. 河北醫藥, 2019, 41(21): 3253-3256.
39. Oguzhan N, Pala C, Sipahioglu MH, et al. Locking tunneled hemodialysis catheters with hypertonic saline (26% NaCl) and heparin to prevent catheter-related bloodstream infections and thrombosis: a randomized, prospective trial. Ren Fail, 2012, 34(2): 181-188.
40. Zhao T, Liu H, Han J. Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis. Int Urol Nephrol, 2018, 50(9): 1643-1652.
41. Schilcher G, Schlagenhauf A, Schneditz D, et al. Ethanol causes protein precipitation--new safety issues for catheter locking techniques. PLoS One, 2013, 8(12): e84869.
42. Tasca Okamoto GF, Oliveira Portela FS, Alexandrino da Silva MF, et al. Intraoperative evaluation of tunneled dialysis catheter mobility and function with arm movement. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 146-151.
43. 吳健誼, 賈中尉, 楊林. 帶 cuff 的中心靜脈導管接頭破損原因分析及護理對策. 護理學雜志, 2019, 34(15): 50-51.
44. Parvulescu F, Oliver MJ, Reyna ME, et al. Factors affecting cuff extrusion of tunneled hemodialysis catheters. Can Assoc Radiol J, 2022, 73(2): 410-418.
45. 朱幼平, 袁慧中. 維持性血液透析患者帶 Cuff 的中心靜脈導管移位的原因及預防. 鄂州大學學報, 2016, 23(5): 110-112.
46. 鄢成靜, 于洋, 周莉, 等. Caprini 靜脈血栓風險評估模型在隧道式 cuff 透析導管功能不良伴中心靜脈血栓患者中的有效性. 中華腎臟病雜志, 2017, 33(6): 429-434.

West China Medical Journal

Research progress on tunnel-cuffed catheter placement and maintenance in maintenance hemodialysis patients

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