Temporary Vascular Access For Hemodialysis Research Articles

Ultrasound assisted catheterization of internal jugular vein

An appropriate vascular access is always needed for the success of hemodialysis. Internal jugular vein is the safest and less complicated access in between central veins. At the same time, it is the most commonly used temporary vascular access for hemodialysis. The blind method after anatomical marking for the central vascular path is the most used technique in many centers. The use of ultrasound in the placement of hemodi-alysis catheters in the central vein increases the success rate of catheterization. Ultrasound can show IJV locali-zation, anatomical variations, the presence of thrombus in the vein, and whether the vein is open. The aim of this study is to compare the success rate and complication frequency of temporary catheters placed in the IJV with and without ultrasound for hemodialysis. A total of 124 consecutive patients who required hemodialysis catheters in Haydarpaşa Numune Trai-ning and Research Hospital between February 2012 and December 2012 were randomized to the study. The patients were divided into two groups as non USG-assisted (blindly) (Group 1) and ultrasound-assisted (Group 2). The use of ultrasound significantly increased the successful catheterization rates of both experienced specialist and resident. In addition, there was no statistical difference between the success rates between the specialist and the resident. USG-assisted vein catheterization can be performed safely, easily, quickly, more painlessly and with minimal complication rates. Catheter intervention should be performed under the guidance of USG in risky patient groups who need temporary catheters. In centers that do not have USG, especially in such risky patients, blind catheter interven-tion should not be attempted after anatomical marking. USG-assisted vein catheterization can be easily perfor-med by all clinicians and residents, since the training period is short, practical and much more safe.

Training Nephrology Fellows in Temporary Hemodialysis Catheter Placement and Kidney Biopsies is Needed and Should be Required.

Proficiency in performing percutaneous kidney biopsies and placing temporary vascular access for hemodialysis (nontunneled catheters) has been a requirement of nephrology fellowship training in the United States since at least the 1980s. A lot has changed since then, but in my opinion, the need to

Non-Insertion-Related Complications of Central Venous Catheterization—Temporary Vascular Access for Hemodialysis

The authors analyzed 309 central venous catheters (CVC) inserted in 147 hemodialysis patients before the maturation of the first or new arteriovenous fistula. One clinical manifestations of sepsis after CVC insertion was found. In all, 33.7% of the catheters were removed because of early minor complications: CVC occlusion, inadequate blood flow in CVC, shattered suture and malposition of CVC, fever, signs of infection at the site of CVC insertion, and bleeding at the site of CVC insertion. The most frequently isolated pathogenic bacteria at the tips of the catheters were coagulase-negative staphylococci highly sensitive to vancomycin and gentamicin.

A Rare Complicatıon of Internal Jugular Vein cannulatıon: horner's syndrome

Internal jugular vein cannulation has become the preferred approach for temporary vascular access for hemodialysis. Internal jugular vein cannulation is associated with a high rate of successful catheter placement. However, significant complications such as internal carotid artery (ICA) puncture, vessel erosion, thrombosis and infection can occur. We present one case of Horner’s syndrome (without arterial punction) occurring following internal jugular venous cannulation. We suggested that, clinicians need to be aware of the risk of Horner’s syndrome as a possible complication of percutaneous hemodialysis catheterization via the internal jugular vein and should avoid repeated manipulations.

A Prospective Randomized Study to Compare Ultrasound-Guided with Nonultrasound-Guided Double Lumen Internal Jugular Catheter Insertion as a Temporary Hemodialysis Access

Internal jugular venous catheters (IJVC) for hemodialysis are a commonly employed temporary vascular access for hemodialysis. Most hospitals still follow the use of blind technique, which uses anatomical landmarks. Even in the most experienced hands this procedure has a variable success rate. Ultrasound guidance can decrease the incidence of periprocedural complications and improve the success rate. In this randomized study we compared the procedure success rate and periprocedural complications in patients undergoing ultrasound guided vs. nonultrasound guided IJVC insertion for a temporary hemodialysis access. Methods. All patients subjected to insertion of an IJVC between March 2004 and June 2004 were enrolled into the study, randomized to either the blind (group A) or ultrasound guided (group B) procedure, which uses a portable ordinary ultrasound machine without a needle guide. The aseptic Saldinger technique was used for catheterization in both the groups. Baseline characteristics of patient and periprocedural events were recorded. Results. A total of 60 patients were randomized, 30 patients each in two groups. First attempt venous cannulation success rate was 56.7% in group A compared to 86.7% in group B. Chance of occurrence of adverse outcome was significantly more in the blind procedure (P = 0.020). A post-procedure chest radiograph done in all patient showed no complications. Conclusion. Ultrasound guided procedure for internal jugular vein catheter insertion using an ordinary ultrasound machine was significantly safer and more successful as compared to the blind technique.

Risk Factors of Nontunneled Noncuffed Hemodialysis Catheter Malfunction

Background: The use of noncuffed nontunneled central venous catheters is a widely accepted method of gaining temporary vascular access for hemodialysis. Malfunction and bacteremia are the main factors limiting catheter survival. Methods: We followed up prospectively 73 hemodialysis catheters (HC) (40 internal jugular, 33 femoral) in order to establish factors influencing HC malfunction. HC malfunction was defined as a catheter that was unable to attain and maintain blood flows of at least 150 ml/min. 73 HC were used for a total 1,100 days. Results: HC malfunction occurred in 23 cases (31.51%) during the study period, giving an overall rate of 21 episodes per 1,000 catheter days at risk. An analysis revealed a higher risk of HC malfunction with the catheterization of the femoral vein compared to the internal jugular vein (hazard ratio (HR) 6.3; 95% confidence interval (CI) 5.3–7.3). After correction for confounding factors in multivariate Cox analysis, the site of the catheterization remained a statistically significant predictor of HC malfunction (HR 5.03, 95% CI 3.83–6.23). After the first week malfunction rate was 42 and 8% for femoral and internal jugular site, respectively (relative risk (RR) for malfunction 5.3 (95% CI, 2.5–8). After the second and third week, the incidence of malfunction was 51 and 14% for femoral and internal jugular vein, respectively (RR 3.6, 95% CI 2.2–5.1). Conclusions: Catheterization of the internal jugular vein is associated with longer catheter survival when compared to the femoral vein. Hemodialysis catheters should be placed, if possible, in internal jugular vein to prevent their premature malfunction.

Percutaneous catheterization of the internal jugular vein for hemodialysis.

ObjectivesThe present study was aimed at evaluating the clinical experiences in the internal jugular venous catheterization for hemodialysis.MethodsWe retrospectively analyzed the data on internal jugular venous catheterization at Chonnam National University Hospital from May 2000 to Februrary 2001.ResultsThere were 132 uremic patients with a total of 150 attempts of internal jugular cannulation. Overall success rate was 90.9% with average puncture trials of 2.3±2.1. 124 (82.7%) of the catheterization attempts were made on the right side and 26 (17.3%) were made on the left. The catheters were left in place from 2 to 87 days with an average of 19.5±15.3 days per catheter. The dialysis sessions per catheter were from 2 to 58 with an average of 11.3±6.8. The mean blood flow during hemodialysis immediately after catheterization was 213.4±42.2 ml/min. Thirty two (21.3%) patients had early complications. These included carotid artery puncture (11.3%), local bleeding (4.7%), local pain (3.3%), neck hematoma (0.7%) and malposition of the catheter (1.3%). Seventeen (11.3%) patients had late complications. These included fever or infection (11.3%), inadequate blood flow rate (3.3%) and inadvertent withdrawal (2.0%). There was no catheter-related mortality.ConclusionsOur experiences revealed that the internal jugular vein catheterization is relatively safe and efficient for temporary vascular access for hemodialysis.

Ultrasound-Guided Cannulation of the Femoral Vein for Acute Hemodialysis Access with Silicone Catheters

The percutaneous femoral approach for temporary central venous hemodialysis access is a mandatory part of patient management in many clinical settings. It is usually achieved with a blind, exter-nal landmark-guided technique. The aim of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. From 1990 to January 2000, cannulation of the femoral vein was performed on 230 patients (125 male, 105 female, mean age 72 years, range 52-95 years) for temporary vascular access for hemodialysis (172 patients with acute renal failure and 58 patients in end-stage renal disease), using landmark localization with semi-rigid, uncuffed catheters. Between January 2000 and February 2001, ultrasound-guided can-nulation of the femoral vein was utilized in 38 patients (20 male, 13 female, mean age 71 , range 55-93 years) for temporary vascular access for hemodialysis (28 patients with acute renal failure and 10 patients in end-stage- renal failure). Uncuffed, dual-lumen silicone catheters were used. Cannulation of the femoral vein was achieved in 100% of cases using ultrasound, and in 87% using the landmark-guided technique. Using ultrasound, puncture of the femoral artery occurred in 2.6% of patients, and hematoma in 0%. Using the 'blind' technique, puncture of the femoral artery occurred in 11.2% of patients, and hematoma in 3.9%. The average catheter dwell time, in accordance with NKF-DOQI guidelines, was 5 days (range 2 - 14 days) for semi-rigid catheters and 45 days (range 5-120 days) for silastic catheters. The number of complications rose significantly in the patients with semi-rigid catheters. In this group, local exit infection occurred in 105 persons (45% of cases), total catheter thrombosis in 46 (20%), bacteriemia in 28 (12%), and phlebitis of the leg in 6 (2.6%). In the group with silicone catheters local exit infection occurred in 4 patients (10 % of cas-es), total catheter thrombosis in 1 (2.6%), bacteriemia in 2 (5.2%) and phlebitis in 0 (0%). The result of the study suggests that ultrasound-guided cannulation of the femoral vein is superior to traditional techniques relying on anatomic landmark; it reduces the numbers of unsuccessful attempts and the possible acute complications of the procedure. We believe that femoral cannulation with modern flexible silicone catheters can be considered as a reliable temporary access, even for extended periods.

DIRECT PERIPHERAL VENOPUNCTURE: ANOTHER NEW CHOICE OF TEMPORARY VASCULAR ACCESS

Background. Femoral, subclavian, and internal jugular veins access have been widely used for temporary vascular access for hemodialysis, but their use has been associated with a significant complication rate. We report in three selected hemodialysis patients with the procedure of direct peripheral venopuncture as temporary vascular access to reduce complications.Methods. We have demonstrated hemodialysis via direct puncture of peripheral veins of the antecubital fossa (cephalic vein in the process of arterial inflow to dialyzer and venous outflow from dialyzer to basilic vein) as temporary vascular access for these patients.Results. Renal function of case 1 and case 2 progress to normal status after several sessions of dialytic therapy as well as quit hemodialysis, and case 3 successfully shifts to peritoneal dialysis following four sessions of dialytic therapy.Conclusions. We recommend this short-term access contribute a important additional new choice in selected patients with acute, reversible renal failure, obstructive uropathy, initiation of peritoneal dialysis, patients on peritoneal dialysis with peritonitis, or under plasmapheresis therapy.

Permcath as Temporary Vascular Access for Hemodialysis

The efficacy and complications of 30 cuffed, double-lumen silastic catheters (Permcaths) inserted in 24 patients with chronic end-stage renal failure were studied prospectively at the Security Forces Hospital in Riyadh from June 1992 until March 1996. The causes of end-stage renal failure in the 24 patients were diabetes mellitus (10), glomerulonephritis (5), hypertension (2), amyloidosis (1), and bilateral small kidneys of unknown cause (6). Local anesthesia was used in 27 and general anesthesia in 3 patients. Internal jugular, external jugular, and subclavian veins were used in 13, 12, and 5 instances, respectively. The number of dialysis sessions varied from 1 to 292, with a mean of 59 ± 60 sessions. The blood flow was 200 to 350 (280 ± 42) mL/minute. The duration of catheter function varied from 4 to 682 (150 ± 160) days. Six catheters developed poor blood flow due to thrombosis in one of the two lumens. In two, blood flow improved after use of streptokinase 15000 IU/lumen, and four had to be changed. Four patients developed exit-site infection. Staphylococcus aureus was isolated from three of these patients, and all of them improved with systemic antibiotics and local dressing. Acinetobacter was isolated from one exit site and the catheter was changed because there was no response to antibiotics. Four patients developed septicemia; S. aureus was isolated from two, Acinetobacter from one, and one had negative culture. Catheters were removed in two of these patients because there was no response to antibiotic therapy. One patient developed right internal jugular vein thrombosis. The reasons for removal of a Permcath were: poor blood flow (4), death of the patient (3), bleeding and hematoma (2), renal transplantation (2), septicemia (2), exit-site infection (1), use of arteriovenous fistula (1), patient's request (1), and primary failure (1). Eleven catheters were functioning until the end of the study. Two patients were lost for follow-up. In conclusion, Permcath can be used as a temporary as well as a long-term vascular access. It combines the advantages of being able to be used immediately and for an indefinite period that varies from weeks to months.

Use of a silicone catheter with a Dacron cuff for dialysis short-term vascular access.

Polyurethane and Teflon subclavian vein catheters have been widely used for temporary vascular access for hemodialysis, but their use has been associated with a significant complication rate. A silicone dual-lumen catheter with a Dacron cuff placed in the internal jugular or subclavian vein was evaluated as a means of obtaining short-term vascular access. Sixty-two catheters in 54 patients provided a cumulative experience of 206 patient-months. Blood flow rates greater than or equal to 200 mL/min were achieved, with a mean recirculation of 2.1%. Catheter function was better with placement on the right side. Exit-site infections developed in nine patients, for a rate of 5.3 episodes per 100 patient-months; all resolved with antibiotics. Catheter-related bacteremia occurred in one patient, for a rate of 0.49 episodes per 100 patient-months, a rate much lower than rates reported for polyurethane and Teflon catheters. Clotting occurred in 24.5% of catheters, and thrombolytic therapy was always successful in restoring function. Because of the lower rate of complications, the silicone dual-lumen catheter with a Dacron cuff provides a safer alternative for short-term hemodialysis vascular access than the Teflon and polyurethane catheters.

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

How Should Temporary Vascular Access for Hemodialysis Be Achieved?

Subclavian Vein Stenosis as a Complication of Subclavian Catheterization for Hemodialysis

Thirteen patients had placement of a subclavian vein catheter for temporary vascular access for hemodialysis. Peripheral venography was performed within two to six weeks of catheter placement. Forty-six percent (six of 13 patients) developed subclavian vein narrowing, which resolved in two patients. The duration of catheter placement had no impact on the incidence of this complication. Subclavian vein catheterization can frequently lead to subclavian vein stenosis, which often will resolve spontaneously. Consideration should be given to placement of subclavian lines on the contralateral side of a planned permanent vascular access.

Internal jugular vein cannulation with two silicone rubber catheters: a new and safe temporary vascular access for hemodialysis. Thirty months' experience.

Temporary and immediately usable vascular access is a vital need in treating uremic patients. Subclavian vein cannulation, although a major progress, has been associated with significant morbidity and mortality. Accordingly, for the last 2.5 years the authors have been developing an alternative technique consisting of internal jugular vein cannulation (IJVC) with two silicone rubber catheters with a long-term, proved biocompatibility. One hundred sixty-five pairs of cannulas were inserted in 153 patients. Mean duration of use was 57 days (1 day to 17 months). More than 3,000 high-performance hemodialysis sessions were performed. IJVC handling and care were easily managed by nurses. A low incidence of complications was observed: two thrombosis episodes, four skin infections with three septicemia, one air embolism, and one anaphylactoid reaction. No death was related to the technique itself. IJVC offers a new, safe, and reliable temporary vascular access immediately usable for all kinds of extracorporeal treatment.

Temporary vascular access in British hemodialysis units.

A questionnaire, designed to determine the current habits of British nephrologists regarding temporary vascular access for hemodialysis, was sent to 62 renal units. Forty-six (74%) completed questionnaires were returned. Cannulation of the subclavian vein with a single-lumen catheter is the most popular technique. There is only limited use of double- or dual-lumen catheters in the United Kingdom. Previously unreported fatal complications of subclavian hemodialysis catheters are described.

O cateter de subclávia como acesso vascular de urgência para hemodiálise.

O cateter de subclávia como acesso vascular de urgência para hemodiálise.