Dynamic ultrasound-guided hemodialysis catheter insertion

Abstract

Background Hemodialysis catheters are broadly used for both short-term and long-term angioaccess for hemodialysis. Conventional methods of catheter insertion were based on anatomical landmarks but were associated with higher failure rates, more attempts, and higher rate of complications. Dynamic ultrasound (US) guidance for insertion of hemodialysis catheters is described in the recent guidelines and can provide higher success rate, faster access, and significantly lower complication rates. Purpose The objective was to assess the effectiveness and safety of dynamic US guidance during insertion of hemodialysis catheters. Patients and methods This prospective interventional study included 40 patients with end-stage renal disease in need for regular or acute hemodialysis who underwent insertion of hemodialysis catheters by one operator (for each procedure) under dynamic short-axis US guidance. Results A total of 40 hemodialysis catheters were inserted in 40 patients by one operator for each procedure using dynamic short-axis US guidance. Overall, 22 (55%) catheters were inserted through the right internal jugular vein, six (15%) were inserted through the left internal jugular vein, and 12 (30%) were inserted through the femoral veins (nine in the right side and three in the left side). The first-attempt success rate was 85% (catheters were inserted at first attempt in 34 patients), the second-attempt success rate was 5% (in two cases), and the third-attempt success rate was 5%. Catheters were inserted after more than three attempts in 5% of cases. Conclusion The use of one-operator dynamic short-axis US guidance for hemodialysis catheter insertion makes procedure faster and safer. It is important to be familiar with the US techniques, which have become the current standard of care and should be used in all cases.