Hemodialysis international. International Symposium on Home Hemodialysis · 2026
Bedside Placement of Right Internal Jugular Tunneled Dialysis Catheters by Nephrologists Without Fluoroscopy: Safety and Outcomes From a Retrospective Single-Center Study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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P Ganesh Srinivasa Prasad, Sarvepalli Aravind, M Limesh, Nagesh Vinod, Hegde Nitin Kumar
Аннотация
BACKGROUND: Guidelines recommend fluoroscopic guidance for tunneled hemodialysis catheter placement, but fluoroscopy is costly, not universally available, and increases patient radiation exposure. Ultrasound-guided bedside placement by nephrologists, using anatomical landmarks, may provide a safe and cost-effective alternative. To evaluate the immediate safety and outcomes of nonfluoroscopic right internal jugular vein tunneled catheter placement performed by nephrologists in a tertiary care center.
METHODS: Conducted a retrospective analysis of all tunneled dialysis catheters placed bedside at our center between January 2021 and December 2022. Ultrasound was used for venous cannulation, anatomical landmarks for surface marking, and postprocedure chest radiography for tip confirmation. The primary outcome was procedure-related complications within 24 h. Access failure, defined as the inability to use the catheter for dialysis within 24 h, was the secondary outcome.
RESULTS: Among 235 patients (77.4% male; mean age 55.8 years), 7 (2.9%) developed immediate complications. Minor exit-site bleeding occurred in four patients (1.7%), all managed conservatively; two received fresh frozen plasma. Catheter malposition occurred in two cases (0.85%); one required repositioning and the other replacement with a femoral catheter. One patient (0.4%) had a cardiac arrest attributed to acute coronary syndrome unrelated to the procedure. Access failure occurred in one case (0.4%). All remaining catheters functioned successfully for immediate dialysis.
CONCLUSION: Ultrasound-guided, nonfluoroscopic bedside placement of right internal jugular vein tunneled catheters by nephrologists is feasible, safe, and cost-effective. This technique reduces radiation exposure and costs, supporting its role in resource-limited settings. Prospective multicenter studies are warranted to assess long-term patency, infection rates, and dialysis adequacy.
METHODS: Conducted a retrospective analysis of all tunneled dialysis catheters placed bedside at our center between January 2021 and December 2022. Ultrasound was used for venous cannulation, anatomical landmarks for surface marking, and postprocedure chest radiography for tip confirmation. The primary outcome was procedure-related complications within 24 h. Access failure, defined as the inability to use the catheter for dialysis within 24 h, was the secondary outcome.
RESULTS: Among 235 patients (77.4% male; mean age 55.8 years), 7 (2.9%) developed immediate complications. Minor exit-site bleeding occurred in four patients (1.7%), all managed conservatively; two received fresh frozen plasma. Catheter malposition occurred in two cases (0.85%); one required repositioning and the other replacement with a femoral catheter. One patient (0.4%) had a cardiac arrest attributed to acute coronary syndrome unrelated to the procedure. Access failure occurred in one case (0.4%). All remaining catheters functioned successfully for immediate dialysis.
CONCLUSION: Ultrasound-guided, nonfluoroscopic bedside placement of right internal jugular vein tunneled catheters by nephrologists is feasible, safe, and cost-effective. This technique reduces radiation exposure and costs, supporting its role in resource-limited settings. Prospective multicenter studies are warranted to assess long-term patency, infection rates, and dialysis adequacy.