Haemostatic effectiveness of intranasal desmopressin for tunnelled dialysis catheter placement: a pilot randomised controlled trial

Purpose: This study aimed to evaluate the effectiveness of intranasal desmopressin in reducing exit-site bleeding during the placement of tunnelled dialysis catheters. Methods: This open-label randomised controlled trial was done on patients aged ≥ 12 years undergoing placement of tunnelled dialysis catheters. Exclusion criteria included current use of anticoagulants, platelet count < 50 × 109/l, previous tunnelled dialysis catheter insertions at the same site, blood pressure > 180/110 mmHg, and unwillingness. Patients in the intervention arm were administered intranasal desmopressin, 10 μg in each nostril, 30 min before the procedure. Patients in the control arm did not receive desmopressin. All patients were monitored for bleeding from the TDC exit site for 24 h after the procedure. For persistent bleeding, a purse-string suture was applied approximately 1 cm from the exit site. Results: There were 86 patients aged 56.41 ± 15.64 years. The majority of the catheters (79; 91.86%) were placed in the right internal jugular vein. In the intervention arm, six patients (13.95%) experienced bleeding from the catheter exit site, compared to eleven patients (25.58%) in the control arm (p = 0.176). Purse-string suturing was required for six (13.95%) patients in the intervention arm and ten (23.26%) patients in the control arm (p = 0.268). No patient reported significant side effects. Conclusion: There was a statistically insignificant reduction in exit-site bleeding with intranasal desmopressin. Trial registry: Iranian Clinical Trial Registry (IRCT20240215061017N2) © The Author(s), under exclusive licence to Springer Nature B.V. 2026.