Skip Navigation


NDT Advance Access originally published online on October 30, 2007
Nephrology Dialysis Transplantation 2008 23(1):420-421; doi:10.1093/ndt/gfm606
This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/1/420    most recent
gfm606v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Vachharajani, T. J.
Right arrow Articles by Moossavi, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vachharajani, T. J.
Right arrow Articles by Moossavi, S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Sheathless or ‘over-the wire’ technique for tunnelled cuffed catheter insertion

Email: tvachhar{at}wfubmc.edu

Sir,

We read with great interest the article by Polakovic et al. [1] regarding the insertion of tunnelled cuffed catheters without using a peel-away sheath. This technical note is very helpful, as increasing number of nephrologists are performing these procedures. We have switched over to this sheathless or ‘over the wire’ technique for the past 3 years now [2]. It certainly reduces the amount of blood loss and possibly also decreases the risk of air embolism [3]. The advantage of avoiding the sheath is primarily to reduce the venotomy size, thus allowing the catheter to fit snugly, preventing oozing around the venotomy site. We have been using this technique not only for new insertions, but also for replacements. The technique works equally well with both split and stepped catheter tips. In case of split catheter tip, the wire is weaved through the venous tip, then brought out through the side hole of the venous lumen. The wire is then passed into the tip of the arterial end and pulled out through the arterial hub.

Moreover, with the availability of tunnelled catheters with a ‘stiffener’ or stylet makes using this technique simple, even for a novice. The sheathless technique can be difficult in patients who have multiple previous catheters or scarring and hence we recommend having a valve-sheath handy in case of an emergency.

Conflict of interest statement. None declared.

Tushar J. Vachharajani and Shahriar Moossavi

Department of Internal Medicine
Section of Nephrology Wake Forest
University School of Medicine
Winston-Salem, NC, 27157 USA

References

  1. Polakovic V, Svára F, Dvoráková M. Dialysis catheter insertion with and without peel-away sheaths. Nephrol Dial Transplant (2007) 22:2359.[Free Full Text]
  2. Vachharajani TJ, Atray NK. Invasive and innovative nephrology. Ren Fail (2005) 27:255–258.[CrossRef][Web of Science][Medline]
  3. Patel A, Hofkin S, Ball D, Cohen G, Smith DC. Sheathless technique of Ash Split-Cath insertion. J Vasc Interv Radiol (2001) 12:376–378.[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/1/420    most recent
gfm606v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Vachharajani, T. J.
Right arrow Articles by Moossavi, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vachharajani, T. J.
Right arrow Articles by Moossavi, S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?