The Hidden Risks of Long-Term Catheter Use: What You Need to Know
"While permanent catheters offer convenience, a less-known complication—the 'stuck catheter'—can lead to serious health issues. Learn how to prevent and manage this hazardous twist."
In nephrology, ensuring a well-functioning vascular access is critical. Catheters have become more common with the rise in dialysis prevalence, offering a solution for those with conditions that prevent arteriovenous (AV) access. These conditions include peripheral vascular disease, congestive heart failure, AV-access aneurysms, vascular steal phenomenon, and exhausted vascular access sites.
Tunneled catheters are often favored for their ease of use and convenience, but this preference comes with increased risks. Complications and the need for catheter removal are significant concerns. One such complication is the 'stuck catheter,' where the catheter adheres to the vessel wall, requiring invasive interventions for removal.
This article explores the 'stuck catheter' phenomenon and its consequences, drawing on a retrospective review of tunneled hemodialysis catheters. Understanding this complication can help improve patient care and outcomes.
Milestones in Dialysis Access
The history of dialysis began more than two centuries ago with experiments by Thomas Graham and eventually led to Willem Kolff's creation of the hemodialysis machine. The first human dialysis treatment took place in 1924 in Germany, when Dr. George Haas used two external cannulas, one connected to an artery and the other to a vein through surgical cutdown. Dialysis technology did not reliably save lives until the mid-1940s, while vascular-access development continued alongside advances in hemodialysis technology.
What is a 'Stuck Catheter' and Why is it a Problem?
A 'stuck catheter' occurs when a tunneled catheter resists removal due to adherence to the vessel wall. Normally, a catheter should slide out smoothly after the fibrous sheath is dissected from the surrounding cuff. However, in rare cases, the catheter becomes tethered, necessitating more aggressive interventions.
- Infection Risk: Stuck catheters can increase the risk of infections, potentially leading to severe complications.
- Vascular Damage: Aggressive removal attempts can damage the vessel wall, causing further complications.
- Increased Morbidity: Surgical interventions to remove stuck catheters are associated with higher morbidity rates.
- Loss of Access: The affected vascular access site may become unusable for future catheter placements.
What Recent Studies Examine
Recent research is examining very long-term central venous access devices used for home parenteral nutrition in adults. An international cross-sectional survey evaluated clinicians' experience managing tunneled or port catheters used for more than 10 years and peripherally inserted central catheters used for more than 2 years, including opinions about elective replacement. Other studies address removal of long-term pediatric ports, reporting a mean dwell time of 39.35 months, and training and practice surrounding tunneled hemodialysis catheter removal. One cited single-centre review of more than 2,000 removals reported complications in 0.92% of cases.
Limits of Current Removal Strategies
Long-term catheter use remains common for various reasons, including patient-related factors, and embedded catheters therefore require recognition and appropriate management. An endoluminal dilatation technique was reported as safe and effective without complications in a series of 15 patients cited by one case report. However, the exact mechanism of catheter adherence is still unclear because not every patient with prolonged catheter implantation develops the complication. Another source notes that several removal strategies have been published, but there is no consensus on the best approach.
Access Choices and Complications
A randomized pilot study compared metal needles with plastic cannulae for complications, including aneurysms and stenotic lesions, along cannulation sites in the arteriovenous access of hemodialysis patients. Separate reports examine stuck hemodialysis catheters, including a multicentre Italian survey of 72 cases. A case report describes central venous catheters as an effective short- to mid-term alternative while permanent access matures, but links prolonged use to thrombosis and fibrosis around the central vein. These sources compare different access approaches while highlighting that catheter-related complications can become more difficult to manage over time.
How to Prevent and Manage Stuck Catheters
While retention of tunneled central venous catheters is rare, it is an important complication of prolonged catheter use. Nephrologists should be aware of this complication and its subsequent management. Endoluminal balloon dilatation procedures can be the initial approach to address the issue. In patients who fail less invasive endovascular procedures and are considered at high surgical risk, embedding the catheter after ligation and proximal division of the ports is an option with subsequent surveillance for and timely management of complications, such as sepsis.
Managing Stuck Catheters
A retrospective study examined treatment options for stuck tunneled cuffed catheters in 13 patients undergoing maintenance hemodialysis. A separate report presents an Italian survey of 72 stuck hemodialysis catheters and describes how this complication was managed across multiple centres. Together, these sources show that stuck-catheter management has been addressed through clinical experience and reported case series. The available material focuses on treatment approaches rather than identifying a single universally established solution.
The Need for Specialized Expertise
Stuck hemodialysis catheters are described as an increasingly reported complication associated with tunneled catheter use. Management may require nephrologists to understand removal techniques involving interventional radiology and surgery. These procedures also carry risks, making the choice of approach clinically important. The broader challenge is ensuring that clinicians can recognize the problem and coordinate appropriate specialist management.
When Removal Becomes Complex
A case reported after kidney transplantation involved a 66-year-old woman who had undergone hemodialysis with a tunneled-cuffed catheter left in place for five years. The catheter became difficult to remove because of fibrotic adhesion, illustrating how a device used during one phase of care can create a problem during a later transition. Another case involved a 45-year-old man whose catheter had been placed in the left subclavian vein eight months earlier and became stuck in the central vein. These reports describe removal as complex when fibrosis or central venous location is involved.