Application of transesophageal echocardiography for hemodialysis tunneled cuffed catheter dysfunction

Objective To explore the application value of transesophageal echocardiography （TEE） for evaluating hemodialysis tunneled cuffed catheter （TCC） dysfunction. Methods From March 1, 2020 to July 31, 2022, 28 patients hospitalized at Central Municipal Hospital for hemodialysis with tunneled cuffed catheter （TCC） dysfunction. Both TEE and digital subtraction angiography（DSA） were performed for observing the status of catheter routing, thrombus, fibrin sheath and central venous disease, etc. Positive criteria for TEE/DSA if one or more of the following:（1）catheter-related thrombosis （CRT）; （2） fibrin sheath around duct; （3） central venous stenosis; （4）narrow chamber junction;（5）catheter in an inappropriate position. With DSA as a gold standard, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TEE results were analyzed. Receiver operating characteristic（ROC） curve and area under ROC curve（AUC） were employed for examining the accuracy of TEE and verifying the consistency of two inspection results. Results Among them,18 were TEE positive and 16 DSA positive. As compared with DSA results, TEE had a sensitivity of 87.5%, a specificity of 66.7%, an accuracy of 78.6%, a positive predictive value of 77.8% and a negative predictive value of 80%. AUC of 0.771 [95%CI （0.582, 0.960）], P = 0.016;Kappa = 0.553, P = 0.003] hinted at consistency between TEE/DSA results. Conclusion As an important modality of evaluating TCC dysfunction, TEE offers the advantages of non-invasiveness, affordability and convenience. It may guide the diagnosis and treatment of TCC dysfunction and is worthy of wider popularization.