A case involving a very elderly hemodialysis patient with a tunneled cuffed central venous catheter firmly attached to a blood vessel wall

Abstract

The patient was a 94‒year‒old female. One year and four months before admission, she had started undergoing hemodialysis through a tunneled cuffed central venous catheter in the left internal jugular vein for end‒stage renal failure caused by nephrosclerosis. She was admitted to hospital because of worsening right shoulder pain caused by bruises from a fall 2 days earlier and hypotension during hemodialysis. On the 10th day of hospitalization, we attempted to remove the catheter due to inadequate blood flow during dialysis, but we could not remove it, even though the subcutaneous cuff had been dissected. On the 11th day of hospitalization, a guidewire was inserted into the catheter under fluoroscopic angiography, and the catheter was removed after detaching it from the blood vessel wall. In Japan, the use of long‒term indwelling catheters is increasing with the aging of hemodialysis patients, and careful attention should be paid to cases in which catheter removal is difficult.