Broken, Inflated Angioplasty Balloon on a Wire

In our hospital, management of poorly functioning dialysis catheters is a daily occurrence. Our algorithm is to first exchange the dysfunctional catheter over guide wires and test the new catheter by rapidly withdrawing blood using a 10-mL syringe. If blood cannot be rapidly aspirated, the new catheter is removed over guide wires and angioplasty of the superior vena cava (SVC) is performed to disrupt the offending fibrin sheath or dilate the caval stenosis. We rarely perform catheter stripping as we have not found this practice to be superior to catheter exchange, and compared with catheter exchange, it is a lengthier and more complex procedure.