Agitated saline bubble–enhanced ultrasound for the positioning of cuffed,tunneled dialysis catheters in patients with end-stage renal disease

Abstract

Background:

In patients with end-stage renal disease, the use of cuffed, tunneled dialysis catheters for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique.

Methods:

From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with end-stage renal disease who required tunneled dialysis catheter placement.

Results:

The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (±0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (±38) mL/min. The total number of catheter days was 7451, with a mean of 133 days and a range of 46–322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively.

Conclusion:

Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology. Future research should further develop and confirm these initial findings.

Keywords

Tunneled dialysis catheters dynamic ultrasound-imaging-based end-stage renal disease

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References

Pereira

Osiason

Salsamendi

Vascular access for placement of tunneled dialysis catheters for hemodialysis: a systematic approach and clinical practice algorithm. J Clin Imaging Sci 2015; 5: 31.

Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kid Dis 2006; 48(Suppl. 1): S243–S273.

Murea

Brown

Divers

et al . Vascular access placement order and outcomes in hemodialysis patients: a longitudinal study. Am J Nephrol 2017; 46: 268–275.

Quarello

Forneris

Borca

et al . Do central venous catheters have advantages over arteriovenous fistulas or grafts? J Nephrol 2006; 19: 265–279.

Moran

Prosl

Totally implantable subcutaneous devices for hemodialysis access. Contrib Nephrol 2004; 142: 178–192.

Klouche

Amigues

Deleuze

et al . Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure. Am J Kidney Dis 2007; 49: 99–108.

Mendu

May

Kaze

et al . Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study. BMC Nephrology 2017; 18: 351.

Falk

Parthasarathy

Conversion of temporary hemodialysis catheters to tunneled hemodialysis catheters. Clin Nephrol 2005; 63: 209–214.

Motta Elias

da Silva Makida

Abensur

et al . Insertion of tunneled hemodialysis catheters without fluoroscopy. J Vasc Access 2010; 11: 138–142.

10.

Yevzlin

Song

Sanchez

et al . Fluoroscopically guided vs modified traditional placement of tunneled hemodialysis catheters: clinical outcomes and cost analysis. J Vasc Access 2007; 8: 245–251.

11.

Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48(Suppl. 1): S2–S90.

12.

Rabindranath

Kumar

Shail

et al . Use of real-time ultrasound guidance for the placement of hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis 2011; 58: 964–970.

13.

Saul

Doctor

Kaban

et al . The ultrasound-only central venous catheter placement and confirmation procedure. J Ultrasound Med 2015; 34: 1301–1306.

14.

Koroglu

Demir

Koroglu

et al . Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients. Acta Radiol 2006; 47: 43–47.

15.

Headley

Thompson

Carter

et al . The role of real-time ultrasound and physical examination measurements in placement of cuffed-tunneled hemodialysis catheters. Nephrol Nurs J 2004; 31: 407–410.

16.

Volpicelli

Elbarbary

Blaivas

et al . International evidence-based recommendations for point-of-care lung ultrasound. Int Care Med 2012; 38: 577–591.

17.

Scher

Shariff

Strategies for hemodialysis access: a vascular surgeon’s perspective. Tech Vasc Interv Radiol 2017; 20(1): 14–19.

18.

Miller

Balter

Schueler

et al . Clinical radiation management for fluoroscopically guided interventional procedures. Radiology 2010; 257(2): 321–332.

19.

Cho

Lee

Kim

SR.

The intracavitary ECG method for insertion of a tunneled dialysis catheter without using fluoroscopy. J Vasc Access 2015; 16(4): 285–288.

20.

Da Hora Passos

Ribeiro

Neves

et al . Agitated saline bubble-enhanced ultrasound for assessing appropriate position of hemodialysis central venous catheter in critically III patients. Kidney Int Rep 2017; 2: 952–956.

21.

Hourmozdi

Markin

Johnson

et al . Routine chest radiography is not necessary after ultrasound-guided right internal jugular vein catheterization. Crit Care Med 2016; 44(9): e804–e188.

22.

Romero

Frey

Schwamm

et al . Cerebral ischemic events associated with “bubble study” for identification of right to left shunts. Stroke 2009; 40: 2343–2348.

23.

Bassett

Lin

Tran

et al . Evaluating the potential risks of bubble studies during echocardiography. Perfusion 2015; 30: 219–223.

24.

O’Neill

WC.

Renal relevant radiology: use of ultrasound in kidney disease and nephrology procedures. Clin J Am Soc Nephrol 2014; 9: 373–381.

25.

Vats

HS.

Complications of catheters: tunneled and nontunneled. Adv Chronic Kidney Dis 2012; 19(3): 188–194.

26.

Berns

Ellison

Linas

et al . Training the next generation’s nephrology workforce. Clin J Am Soc Nephrol 2014; 9(9): 1639–1644.

27.

Vezzani

Brusasco

Palermo

et al . Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography. Crit Care Med 2010; 38: 533–538.

28.

Maury

Guglielminotti

Alzieu

et al . Ultrasonic examination: an alternative to chest radiography after central venous catheter insertion? Am J Respir Crit Care Med 2001; 164: 403–405.

29.

Nguyen

Prat

Vincent

et al . Determination of the learning curve for ultrasound-guided jugular central venous catheter placement. Intensive Care Med 2014; 40: 66–73.

30.

Ganeshan

Warakaulle

Uberoi

Central venous access. Cardiovasc Intervent Radiol 2007; 30: 26–33.

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