Safety and efficacy of placement of tunneled hemodialysis catheter without the use of fluoroscopy

Pethő, Ákos; Tapolyai, Mihály; Szakács-Pál, Timea; Orosz, Petronella; Dézsi, László; Rosivall, László

doi:10.5414/cn110076

Cited by 6 publications

(7 citation statements)

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“…When the CVC tip is outside the observation range, radiography examination is required to view the superior vena cava system; Rossi advocated radiography examination in cases of procedural uncertainty or clinical doubt. This strategy greatly reduces the number of radiography examinations while obtaining clearer tip positions and reducing patient radiation and cost [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

The value of transthoracic echocardiography and chest X-ray in locating the tip of central venous catheter in dialysis patients: a comparative study with computed tomography imaging

Zhang,

Liu,

et al. 2023

Renal Failure

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To determine the tip position of the central venous catheter (CVC) in patients with dialysis, the guidelines recommend that it be determined using chest radiography (CXR) after catheterization, without fluoroscopy. However, some researchers have proposed that transthoracic echocardiography (TTE) can replace CXR, but this has not been widely adopted. This study aimed to determine which of the two aforementioned methods is more suitable for locating the tip position of the CVC. This prospective study included 160 patients who underwent hemodialysis at our hospital from March 2021 to December 2022. After inserting the CVC through the internal jugular vein, we used transthoracic echocardiography and CXR to determine the tip of the CVC and compared the results with those of computed tomography (CT). In the comparison between TTE and CXR for locating the CVC tip, we obtained three main findings. (1) TTE was associated with fewer misdiagnosed cases than CXR. (2) TTE provided higher sensitivity (similar sensitivity in position 2), specificity, positive/negative predictive values, and accuracy than CXR. (3) When comparing the receiver operating characteristic curves of TTE and CXR, the area under the curve (95% confidence interval) for the former was larger. Additionally, we made anatomical discoveries: the "hyperechoic triangle" recognized by TTE was equivalent to the entrance of the superior vena cava into the right atrium shown by transesophageal transthoracic echocardiography. TTE is more suitable than CXR as the first examination for CVC tip localization, as it improves diagnostic accuracy and reduces X-ray radiation damage.

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Section: Discussionmentioning

confidence: 99%

The value of transthoracic echocardiography and chest X-ray in locating the tip of central venous catheter in dialysis patients: a comparative study with computed tomography imaging

Zhang,

Liu,

et al. 2023

Renal Failure

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“…However, it is not always easy to use fluoroscopy when needed if a hospital does not have its own nephrology angiography suite. Several studies previously reported the safety and comparable patency of tunneled HD catheter insertion or exchange from non-tunneled without fluoroscopy [7][8][9][10][11][12]. More recently, some authors reported the additional benefits of tunneled HD catheter insertion without fluoroscopy from the perspective of coronavirus 2019 (COVID-19) infection prevention [1,13].…”

Section: Discussionmentioning

confidence: 99%

Safety and durable patency of tunneled hemodialysis catheter inserted without fluoroscopy

Kim,

Youn,

Ban

et al. 2023

Kidney Res Clin Pract

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Background: A tunneled hemodialysis (HD) catheter is preferred due to its lower incidence of infection and malfunction than non-tunneled ones. For safer insertion, fluoroscopic guidance is desirable. However, if the patient is unstable, transfer to the fluoroscopy may be impossible or inappropriate. Methods: From June 2019 to September 2022, 81 tunneled HD catheter insertion cases performed under ultrasound guidance without fluoroscopy and 474 cases with fluoroscopy in our institutional HD catheter cohort were retrospectively compared. Results: Immediate complications, later catheter-associated problems, including infections and catheter dysfunction, were comparable between the two groups (p = 0.20 and p = 0.37, respectively). The patency of tunneled catheters inserted without fluoroscopy was comparable to the patency of tunneled catheters inserted with fluoroscopic guidance (p = 0.90). Conclusion: Tunneled HD catheter insertion without fluoroscopy can be performed safely and has durable patency compared to the insertion with fluoroscopy. Therefore, this method can be considered for the selected unstable patients (e.g., ventilator care) in the intensive care unit.

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“…8 However, catheter malposition and malfunctioning have remained a relevant issue particularly in those centers where fluoroscopy is not routinely available to monitor guidewire advancement. 9 HD catheter malposition within the LSIV is more likely to occur in cases of repeated or protracted central vein catheterization leading invariably to partial or complete occlusion of the superior vena cava. Usually, the LSIV has a diameter of 2.3 ± 1.1 mm (mean, SD) while standing with a 1-2 mm increase during a supine position.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Fluoroscopy guidance can prevent the passage of the guidewire into the LSIV. 11 However, as stated before, the availability of fluoroscopic support varies across the world 9 and many centers do not have a cardiology laboratory or fluoroscopic equipment within their reach to monitor catheter insertion on a routine basis. As the use of a non-tunneled HD catheter as a first choice vascular access is common, it would not be so speculative to assume that this malposition might be observed a little more frequently in the future.…”

Section: Discussionmentioning

confidence: 99%

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Acute hemodialysis catheter follows the path of least resistance

Salgado

Vachharajani

2021

J Vasc Access

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The placement of large bore double-lumen catheters for hemodialysis (HD) is one of the most frequent procedures performed in HD patients. However, these procedures are associated with complications, the most common being catheter malposition. In this context, catheter deviation to the left superior intercostal vein (LISV) is a very uncommon malposition, which must be differentiated from intrathoracic extravascular catheter lodgment. We report a case of an adult male patient on hemodialysis who presented with a thrombosed arteriovenous fistula and requiring urgent HD. His past medical history included hemophilia, allergy to contrast media, and multiple previous central vein catheterizations. A non-tunneled HD catheter was placed without any difficulty in the left internal jugular vein. However, the arterial lumen failed to pull any blood with free flow in the venous lumen. A chest X-ray revealed a surprising finding. The malpositioned catheter was removed successfully without any complications.

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Safety and efficacy of placement of tunneled hemodialysis catheter without the use of fluoroscopy

Cited by 6 publications

References 0 publications

The value of transthoracic echocardiography and chest X-ray in locating the tip of central venous catheter in dialysis patients: a comparative study with computed tomography imaging

The value of transthoracic echocardiography and chest X-ray in locating the tip of central venous catheter in dialysis patients: a comparative study with computed tomography imaging

Safety and durable patency of tunneled hemodialysis catheter inserted without fluoroscopy

Acute hemodialysis catheter follows the path of least resistance

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