Renal Unit, The General Infirmary at Leeds, Leeds, UK
Keywords: fibrin sheath; Tesio; tunnelled haemodialysis catheter
A 65-year-old patient with a renal allograft underwent cystectomy and creation of ileal conduit for bladder cancer, which resulted in the failure of renal transplant. The patient had no mature native vascular access and was dialysed on a temporary and later a dual lumen tunnelled haemodialysis line (Tesio). Flows in the Tesio catheter were poor and the lines were removed because of the maturation of a Cimino fistula, making it redundant.
Figures 1 and 2
show the two limbs of the tunnelled haemodialysis catheter, and clearly visible on the red dialysis line is a large fibrin sheath covering the ports on the line and responsible for impaired flows.
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The fibrin may be disrupted by infusion through or instillation into the line of thrombolytic drugs such as urokinase or rTPA, or by physically stripping the line by the use of snares introduced via a second venepuncture site and passed over the line [1].
Conflict of interest statement. None declared.
Notes
Correspondence and offprint requests to: Dr R. K. Peel, Renal Unit, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. Email: robpeel{at}doctors.org.uk
Reference