Routine Use of Ultrasound to Avert Mechanical Complications During Placement of Tunneled Dialysis Catheters for Hemodialysis
Amrit Hingorani, Anil Hingorani, Enrico Ascher, Natalie Marks.
Vascular Institute of New York, New York, NY, USA.
While placement of tunneled dialysis catheters for hemodialysis access is considered a routine procedure, it is associated with a small chance of mechanical complications. Since the literature examining these issues is not recent and our impression of the incidence of these post-procedural complications was at variance with the pre-existing publications, we decided to review our experience.
Since 1998, our vascular service has placed 1766 Tesio dialysis catheters in 1065 patients for hemodialysis access. The average age of the patients was 61 ± 21 (SD) years. 44 % were female. 93 % were placed in the right internal jugular vein 7% in the left internal jugular vein. The prevalence of diabetes and hypertension was 52% and 72% respectively. All catheters were placed with ultrasound guidance for the puncture with the selective use of a micropuncture set for patients with low volume status. All patients underwent chest X-ray at the end of each procedure.
In this consecutive series, no case of post-procedure hemothorax or pneumothorax was encountered. Two cut-downs had to performed due to injury to branches of the external carotid artery. 3 patients had to have a subsequent revision of the catheter due to malpositioning of the catheter.
Using modern day techniques, the incidence of mechanical complications for placement of Tesio catheters is quite low. Further data is needed to confirm these data and revise the standard of care for these complications.
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