Retained tunneled dialysis catheter presenting with complete exit site healing: A case report

Tunneled dialysis catheter removal is a common procedure traditionally performed in interventional radiology or the operating room. Prompt removal of unnecessary or dysfunctional catheters is important to reduce the risk of catheter-related complications, including bloodstream infection and thrombosis. We report a rare case of a retained tunneled dialysis catheter presenting with no visible external catheter and a completely healed exit site. An 80-year-old female with end-stage kidney disease requiring maintenance hemodialysis presented to the emergency department with facial swelling and concern for a previously removed dialysis catheter. Physical examination revealed no visible catheter; however, chest radiography demonstrated a retained left-sided tunneled dialysis catheter. Further evaluation identified a palpable catheter cuff despite the absence of an external catheter or identifiable exit site. Computed tomography angiography demonstrated partial thrombosis of the distal left internal jugular vein and occlusion of a previously placed left axillary venous stent, supporting significant central venous disease. Following multidisciplinary consultation, the retained catheter was successfully removed at the bedside using local anesthesia and blunt dissection. Because ongoing hemodialysis access was required, a femoral tunneled dialysis catheter was subsequently placed at the bedside, allowing continuation of dialysis while a maturing arteriovenous fistula progressed to full functionality. The patient underwent successful dialysis and had the femoral catheter removed 9 days later following successful two-needle cannulation of the fistula. The patient was discharged home without complication. This case highlights the importance of meticulous physical examination, careful imaging review, and familiarity with tunneled catheter anatomy in the recognition and management of retained catheter complications. In appropriately selected patients, bedside removal and replacement of tunneled dialysis catheters may represent a feasible management strategy that facilitates timely dialysis access. Further studies are needed to evaluate the broader clinical and operational impact of this approach.