关键词: 带隧道和涤纶套导管, 血液透析, 尿毒症, 无切口拔管技术, 患者耐受度, 手术后并发症

Abstract: Objective  To observe the effect, complication and patient’s tolerance to remove tunnel-cuffed catheter without incision, in order to find out a catheter withdrawal method more suitable for hemodialysis patients.  Method  A total of 19 patients undergoing routine hemodialysis from March 2021 to July 2024 at the Blood Purification Center, Department of Nephrology, Beijing Ditan Hospital affiliated to Capital Medical University were recruited as the experimental group. They were treated with non-invasive method to remove the tunnel-cuffed catheter (direct and blunt separation at the tunnel opening). A total of 20 patients were recruited as the control group; their tunnel-cuffed catheters were removed by traditional cuff separation after incision. Patients’ baseline data were collected.  Result  There were 19 patients in the experimental group, with an average surgical time of 7.95±1.00 minutes, intraoperative blood loss of 1.74±0.17ml, lidocaine hydrochloride dosage of 2.79±0.21ml, and pain tolerance score of 1.96±0.32 points. There were 20 patients in the control group, with an average surgical time of 27.00±2.29 minutes, intraoperative blood loss of 5.05±0.32ml, lidocaine hydrochloride dosage of 5.15±0.44ml, and tolerance pain score of 5.40±0.34. All of the indicators were statistically better in experimental group than in control group (average surgical time: χ2=7.014, P＜0.001; intraoperative bleeding: χ2=9.160, P＜0.001; lidocaine hydrochloride dosage: χ2=4.867, P＜0.001; tolerance pain score: χ2=7.341, P＜0.001). There were no statistical differences in age, gender, dialysis age, catheter indwelling time, reason for catheter removal, occurrence of bleeding and/or hematoma, and postoperative infection between the two groups (age: χ2=0.147, P=0.884; gender: t=0.445, P=0.946; dialysis age: χ2=0.766, P=4.48; catheter indwelling time: χ2=0.729, P=0.470; reason for catheter removal: t=0.174, P=0.676; occurrence of bleeding and/or hematoma: t=1.004, P=3.16).  Conclusion  The non-incision method to remove tunnel-cuffed catheters can shorten the operation time, reduce the amount of bleeding, and decrease the incidence of hematoma, especially can significantly reduce pain and increase patient’s tolerance. This method is safe and effective.

Key words: Tunnel-cuffed catheter, Hemodialysis, Uremia, Non-incision withdrawal technique, Patient’s tolerance, Postoperative complication