Safety and durable patency of tunneled hemodialysis catheter inserted without fluoroscopy

Abstract

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.

Comparison of feasibility and effectiveness of tunneled dialysis catheter placement with or without DSA guidance: a propensity score-matched cohort study

“…Currently, the feasibility and effectiveness of ultrasound-guided TDC insertion compared to fluoroscopy-guided TDC insertion remain unclear. Several studies have compared the outcomes of TDC insertion with and without fluoroscopy [ 9 , 10 ]. However, these studies mainly focused on the success rate of surgery, complications, and long-term postoperative patency of the catheter, with little emphasis on immediate catheter usage, the major goal of hemodialysis catheter placement.…”