1. Could Bring Down The Catheter Exit Site During Catheter Exchange Overt Further InfectionBy
Mohamed El-Maaddawy, Amr Abdulbaky
Professors In Vascular Surgery
Faculty Of Medicine- Cairo University
2016

2. Technique Of Replacing A Temporary Catheter With A Permanent One
A male patient, 75 years old diabetic and hypertensive had CABG 9 years age. He was on Aspirin.
He developed ESRD and was put on regular hemodialysis for one and half month. His right IJV received a Mahurker catheter for his hemodialysis.
He refused to have AVF and preferred to have permeacath for hemodialysis.

3. Technique Of Replacing A Temporary Catheter With A Permanent One
The patient was afebrile and
Has normal level of TLC, ESR and CRP.
CHEST X-ray revealed that the tip of the Mahurker lies in the upper part of the SVC.

4. Technique Of Replacing A Temporary Catheter With A Permanent One
Under local anesthetic, the parkour of the permeacath was marked over the skin and measured to choose the appropriate length of the catheter to be inserted.
The buried part of the catheter is palpated through the skin at one and half cm next to the catheter exit.
A 2 cm transverse incision was made at that point.
Two cm incision was made central to the catheter exit site

5. Technique Of Replacing A Temporary Catheter With A Permanent One
Dissection was deepened to uncover the part of the catheter distal to the catheter exit site and at the same time peripheral to the vein puncture site.

6. Technique Of Replacing A Temporary Catheter With A Permanent One
The catheter was hooked by right angel hemostat.
A 0.038” mandrel wire was advanced through the venous port of the Mahurker and directed to the upper part of the IVC.

7. Technique Of Replacing A Temporary Catheter With A Permanent One
The permeacath was tunneled through the subcutaneous tissue of the chest so that its tip came out through the 2 cm incision.
While being hooked by the right angle hemostat, the catheter was incised by a scalpel and the wire inside was exposed.

8. Technique Of Replacing A Temporary Catheter With A Permanent One
The catheter was clamped central to its incision.
The catheter was cut around the wire, its peripheral end was extirpated and discarded.
The wire was pulled (keeping its distal end into the IVC) until its proximal end came out through the 2 cm incision.

9. Technique Of Replacing A Temporary Catheter With A Permanent One
The wire was kept in place while the remaining part of the catheter was pulled out and discarded.
The past catheter exit site was over sewn by figure of eight polyglycolic acid stitch placed through the 2 cm incision.
The rest of the catheter insertion was carried out according to the operator discretion.

10. Thank you