Ultrasound-guided brachial venous cannulation as a novel venous needle site in hemodialysis patients

Abstract

Key words：subcutaneously fixed artery, vascular access, repeated cannulation, brachial vein, ultrasound-guided cannulation 〈Abstract〉Generally, hemodialysis patients with a subcutaneously fixed artery proceed to arteriovenous graft implantation when their superficial veins are exhausted. Inserting a double lumen hemodialysis catheter, however, could be disadvantage in terms of infection control once the graft has failed due to infection. Under real-time ultrasound guidance, we repeatedly cannulated the brachial vein in two patients whose graft failed due to infection and succeeded in avoiding the insertion of a double lumen catheter until the infection was controlled. Tips for ultrasound-guided cannulation are as follows：1)Locations of the brachial vein, artery and nerve were fully observed in advance. 2)After the brachial vein was visualized on short axis view, the ultrasound probe was slanted and set perpendicular to the hemodialysis needle, which improved visualization of the needle echo,

Vascular Access Puncture Under Ultrasound Guidance

“…5. Note the difference of the appearance between the needle tip and the needle shaft (the echo of the shaft has an eminent acoustic shadow as Kamata et al describe [5]). To confirm that the needle is placed within the vessel, the probe is thrust little by little in accordance with the movement of the needle tip, with the exact tip of the needle on the screen, after appearance of the needle tip (we named this the "looper method") ( Fig.…”

Ultrasound-guided cannulation of hemodialysis access

“…1). The majority of studies have used the transverse approach [9][10][11], and our preference is also this approach. Under transverse imaging, an operator can see the entire circumference of the vein and, thus, transverse imaging facilitates the cannulation of very small veins by enabling the operator to enter the vein right on the top of it.…”

“…Furthermore, with the one-operator technique, by scanning the probe dynamically with coordinated advancement of the needle, highly precise cannulation is possible under transverse imaging. The following is an example of dynamic ultrasound-guided peripheral vascular cannulation using transverse imaging and the oneoperator technique [9]. There are two points: firstly, the target vessel is thoroughly evaluated with ultrasound to determine the entry site.…”

“…On the other hand, the application of ultrasound-guided vascular access, which is now the standard in central venous access, has expanded to peripheral vessels [5][6][7]. Similarly, in the field of dialysis, there are growing indications for its use in cases of difficult peripheral dialysis vascular access, although the number of reports is still limited [8][9][10][11]. Even in Japan, where the prevalence of obesity is lower than in other countries, difficult AV fistula access has increased because of the epidemic of diabetes and aging of the dialysis population.…”