Placement of Hemodialysis Catheters with a Technical, Functional, and Anatomical Viewpoint

Abstract

Aims. Vascular access is of prime importance for hemodialysis patients. We aimed to study early complications of hemodialysis catheters placed in different central veins in patients with acute or chronic renal failure with or without ultrasound (US ) guidance. Material and Methods. Patients who were admitted to our unit between March 2008 and December 2010 with need for vascular access have been included. 908 patients were examined for their demographic parameters, primary renal disease, and indication for catheterization, type and location of the catheter, implantation technique, and acute complications. Results. The mean age of the patients was 60.6 ± 16.0 years. 643 (70.8 %) of the catheters were temporary while 265 (29.2%) were permanent. 684 catheters were inserted to internal jugular veins, 213 to femoral, and 11 to subclavian veins. Arterial puncture occurred in 88 (9.7%) among which 13 had resultant subcutaneous hematoma. No patient had lung trauma and there had been no need for removal of the catheter or a surgical intervention for complications. US guidance in jugular vein and experience of operator decreased arterial puncture rate. Conclusion. US-guided replacement of catheter to internal jugular vein would decrease complication rate. Referral to invasive nephrologists may decrease use of subclavian vein. Experience improves complication rates even under US guidance.

Regional anesthesia with epinephrine‐containing lidocaine reduces pericatheter bleeding after tunneled hemodialysis catheter placement

“…A parameter other than the minute measurement could have been used to quantitatively evaluate the amount of PB (number of sponges) . However, when we look at similar studies in the past, we see that such subjective measures were used (point Likert categorical scale) . Furthermore, this is a single‐center study with a small population and short follow‐up.…”

“…Local anesthetics such as lidocaine are commonly used to reduce pain during the THC placement . In addition, there are commercially available epinephrine‐containing local anesthetic drugs in use.…”

“…In addition, there are commercially available epinephrine‐containing local anesthetic drugs in use. Epinephrine is a potent vasoconstrictor, prolonging anesthesia by slowing vascular uptake of the lidocaine and reducing the bleeding into the wound . It would be a simple solution to use epinephrine‐containing local anesthetics during the THC placement to reduce possible PB and its possible complications.…”

Unsuspected Iatrogenic Vertebral Artery Cannulation With a Dialysis Catheter

“…However, central venous catheter placement should always be done under ultrasound guidance, whenever possible, to prevent or reduce the risk of arterial puncture. 5 …”

Troubleshooting a dialysis line: when blue runs red

“…The primary concern should be the malposition of the catheter into a systemic artery. The incidence of this occurring has been previously reported as high as 11% when choosing an internal jugular vein as the site of catheter insertion, although with the emergence of ultrasound guidance, such complications have become less common 9. Most inadvertent arterial punctures can be detected at the time of the introducer needle placement prior to line insertion based on the colour or pulsatile backflow of the blood.…”