Ultrasound Guided Placement of Tunneled Hemodialysis Catheters

Lee, Beyoung Young; Kim, Cheol Seung; Lim, Hyung Guhn

Abstract

PURPOSE
To evaluate the usefulness of ultrasound guided confirm this change; the symbol has been corrupted in my version placement of tunneled hemodialysis catheters via internal jugular vein (IJV). METHOD: The outcomes of 52 hemodialysis catheters placed from January 2000 through December 2002 were retrospectively analyzed. Of 50 patients, 2 received two catheters. Initially, the patency of the IJV was evaluated with ultrasonography, after which the IJV puncturehe was performed under the guidance of ultrasonography. Under fluoroscopy, a 12.5 F double lumen hemodialysis catheter was placed at the caval atrial junction through a subcutaneous tunnel in the neck. To prevent initial failure we performed a flow test using a 50 cc syringe through the catheters in 47 patients. RESULT: Catheter placements were successful in all patients. Early complication was poorly functioning catheters immediately after placement (initial failure) in two cases (4%). However, no patients developed initial failure after we performed flow test using the 50 cc syringe through the catheters. There were no instances of pneumothorax or hemothorax. Nevertheless, late complications included injured catheters in two cases (4%), bacteremia in five (9.5%), and tunnel infection in 2 (4%). Mean duration of catheter use before removal was 86 days (3~55 days). The blood flow rate at first hemodialysis after catheter placement was 230+/-35.5 ml/min and after 1 month was 248+/-18.6 ml/min. Catheters were removed because of matured arteriovenous fistula in 36 cases (69%), bacteremia in five (9.5%), patient death in 7 (13.5%), injured catheters in two (4%) and tunnel infection in 2 (4%). Symptomatic central venous stenosis was not developed during the study period.
CONCLUSION
Ultrasound guided placement of tunneled hemodialysis catheters via IJV is a safe method, and is useful for patients requiring long-term hemodialysis.