#4216 FEASIBILITY ANALYSIS OF AN ULTRASOUND-GUIDED PLACEMENT OF TUNNELED HEMODIALYSIS CATHETERS

Abstract

Abstract Background and Aims Radiographic fluoroscopy (RAD) is the current standard for placement of tunneled central venous catheters (CVC) for hemodialysis. RAD requires structural and personnel infrastructure and exposes the patient to ionizing radiation. Here, we investigate the feasibility of solely ultrasound-guided placement of tunneled central venous dialysis catheters. Method We evaluated prospectively collected single center data of 134 consecutive patients who underwent CVC implantation between 2020 and 2021 regarding feasibility, safety, and catheter function. We used the inset guidewire to visualize the position of the catheter tip. In the case of inadequate visibility by ultrasound, we additionally used intracardiac ECG recording or agitated saline. A total of 1844 catheter days were assessed. As a historical control, we analyzed the position of 50 CVCs placed by RAD. Optimal CVC position was defined to be in between the cavoatrial junction (CAJ) and the right atrium (RA), according to the guidelines. Results The catheters were placed on the right side in 117 (87%) cases. The primary success rate for optimal position and function was 97,7% (n = 131). Placement solely by ultrasound was possible in 130 (97%) cases. There were no immediate procedure-associated complications related to the new technique. Effective blood flow averaged 292 +/- 39 ml/min. Of all ultrasound-placed catheters, 6% were in the vena cava superior (RAD 24%), 70% in the CAJ (RAD 60%), and 24% in the RA (RAD 16%), resulting in a rate of 94% with optimal position. Conclusion Placement of CVCs for hemodialysis solely by ultrasound is an effective and safe alternative to fluoroscopy-assisted placement.