Placement of Central Venous Dialysis Catheters without X-Ray: Safety and Feasibility

Abstract

Objective: After a placement of central venous catheters chest x-ray is the standard procedure to exclude malpositions and pneumothoraces. In this study we combined ultrasonographic techniques to obviate the routine use of x-ray. Setting: Dialysis Center of the Department of Nephrology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. Patients: 298 consecutive adult patients undergoing central venous catheter placement for hemodialysis. Interventions: None Measurements and Main Results: 298 consecutive patients received a central venous catheter for dialysis by using chest ultrasound to localize the target vessel, guide the puncture, confirm the tip position using agitated saline as a contrast media and to rule out pneumothoraces. The ultrasound results were proven by a chest x-ray after the first dialysis session. During the two years observation period, two catheter malpositions were readily observed with ultrasound and directly corrected in the operation room. Ultrasound of the chest revealed four pneumothoraces, three of them could be confirmed by chest x-ray. Conclusion: The prospective data presented illustrate that the combination of bedside ultrasonographic techniques is not inferior to x-ray. Our method is less time consuming, without radiation exposure and less costly than chest x-ray investigation after central venous catheter placement. As the localization of the tip is based on agitated saline as a contrast media, it adds no infrastructural demands. It is now our well founded believe that the study does challenge the mandatory use of a post insertion x-ray.