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Complicated Cuffed Tunneled Hemodialysis Catheter Insertion in a Cardiac Transplant Patient

Jafar Alsaid*

Cardiac transplant patients are growing in number. AKI with the need for hemodialysis is common among these cases, specifically during the initial phase of their medical course. It is reported that up to 64% of these patients develop AKI of which 28% required hemodialysis. One fifth of these patients ends up having ESRD and requires long term renal replacement therapy. Hemodialysis catheter placement in these patients is crucial for the delivery of renal replacement therapy. Guidelines are lacking in such cases on the preferable central vein to use for the hemodialysis catheter in view of the proximity of the catheter to the cardiac graft. Challenges to insert a cuffed tunneled hemodialysis catheter post cardiac transplant are cardiac assisted devices, central venous congestion and anticoagulation regimen. In this case we would like to share a situation encountered during inserting a Lt. Femoral cuffed tunneled HD catheter with the guidewires entering a dilated iliolumbar venous plexus. With real time fluoroscopy and using iodinated contrast the cuffed tunneled catheter was successfully placed. The requirement for guidelines in these patients is important to assist in providing optimal care.