Value of Ultrasound Guidance in Placement of Hemodialysis Access Catheters in Patients with End-Stage Renal Disease

Abstract

The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. All patients underwent perioperative ultrasound assessment of the venous access site, followed by fluoroscopic confirmation of the catheter placement. Data from medical charts and the hospital computer system were subjected to statistical analysis. A total of 126 patients underwent ultrasound-guided placement of a hemodialysis catheter in a central vein; 58 had undergone prior placement of a central vein catheter, but 69 had not. Patients in the later group had a 100 per cent success rate in catheter placement after ultrasound assessment of one central vein. Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded central veins. This protocol is effective and improves patient safety.

Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine

“…In a study of patients that had undergone CVC insertion 9‐19 weeks earlier, 50% of patients had an IJV thrombosis or stenosis leading to selection of an alternative site. In this study, use of ultrasound for a preprocedural site evaluation reduced unnecessary attempts at catheterizing an occluded vein 41 . At least two other studies demonstrated an appreciable likelihood of thrombosis.…”

“…In this study, use of ultrasound for a preprocedural site evaluation reduced unnecessary attempts at catheterizing an occluded vein. 41 At least two other studies demonstrated an appreciable likelihood of thrombosis. In a study of bariatric patients, 8% of patients had asymptomatic thrombosis 38 and in another study, 9% of patients being evaluated for hemodialysis catheter placement had asymptomatic IJV thrombosis.…”

Continuous Renal-Replacement Therapy for Acute Kidney Injury

“…The preferred site of catheter insertion is the right internal jugular vein. The catheter should be inserted with the use of ultrasonographic guidance [27][28][29] and with adherence to infection-control policies. 30 The use of tunneled catheters is warranted in patients who require prolonged renal-replacement therapy (>1 to 3 weeks) and is associated with a lower rate of infection and thrombosis than the rate associated with nontunneled catheters.…”

Internal Jugular Vein Thrombosis: Etiology, Symptomatology, Diagnosis and Current Treatment

“…In those patients, vascular accesses are long-lasting, so an arteriovenous fistula (AVF) is the most appropriate technique. When an AVF is not technically feasible or when patients require dialysis during the maturation of the AVF, a hemodialysis catheter in the central veins represents the most widely used option [ 29 , 80 , 81 , 82 , 83 ].…”