Dr Andrea Huang1, Dr Jules Catt2, Dr Timothy Spicer1,3, Dr Jeffrey Wong1
1Department of Renal Medicine, Liverpool Hospital, SWSLHD, Sydney, Australia, 2Department of Interventional Radiology, Liverpool Hospital, SWSLHD, Sydney, Australia, 3South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
Background:
The use of transhepatic and translumbar catheters have been described for patients with no other conventional haemodialysis access options. We have previously employed the latter. Here we describe the first case of a haemodialysis patient in our unit who required a transhepatic line.
Case report:
A 51 year old morbidly obese haemodialysis patient with MRSA bacteraemia secondary to an infected right thigh PTFE loop graft in the context of a history of access difficulties had the infected graft ultimately explanted, albeit complicated by a septic shower. A transhepatic (in preference over translumbar) line was inserted 2 days later by interventional radiology with a 31cm 14.5 French Bard tunnelled haemodialysis catheter via the right hepatic vein with the tip positioned within the right atrium. Post procedurally she complained of pain, associated with a drop in haemoglobin by 13g/L and an intra-hepatic haematoma (44x26x28mm) demonstrated on a CT of her abdomen. She dialysed successfully through the transhepatic line on multiple occasions prior to her death 3 weeks after insertion.
Conclusion:
Previously studies have demonstrated a high mortality in patients with hepatic lines which is more likely due to pre-existing patient factors, and a mean catheter-day survival that ranged from 27 to 141.2. Complications secondary to the insertions were low, and the main causes for catheter failure was due to thrombosis. In patients with limited access options or congenital inferior vena cava abnormalities the transhepatic approach remains a viable alternative for dialysis access as was demonstrated in this patient.
Biography:
Andrea Huang is a first year renal advanced trainee currently at Liverpool Hospital. She graduated from University of Sydney in 2017 and trained at Nepean Hospital and Liverpool Hospital.