Agitated saline bubble–enhanced ultrasound for the positioning of cuffed, tunneled dialysis catheters in patients with end-stage renal disease

• Published in: The journal of vascular access 2019-07, Vol.20 (4), p.362-367
• Main Authors: Passos, Rogerio da Hora, Ribeiro, Michel, da Conceição, Luis Filipe Miranda Rebelo, Ramos, Joao Gabriel Rosa, Ribeiro, Juliana Caldas, Batista, Paulo Benigno Pena, Dutra, Margarida Maria Dantas, Rouby, Jean Jacques
• Format: Article
• Language: English
• Subjects: Aged; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheterization, Central Venous - methods; Catheters, Indwelling; Central Venous Catheters; Contrast Media - administration & dosage; Equipment Design; Feasibility Studies; Female; Humans; Kidney Failure, Chronic - diagnostic imaging; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Microbubbles; Middle Aged; Prospective Studies; Renal Dialysis; Saline Solution - administration & dosage; Treatment Outcome; Ultrasonography, Interventional - adverse effects; Ultrasonography, Interventional - methods
• ISSN: 1129-7298; 1724-6032
• DOI: 10.1177/1129729818806121

Background: In patients with end-stage renal disease, the use of cuffed, tunneled dialysis catheters for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique. Methods: From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with end-stage renal disease who required tunneled dialysis catheter placement. Results: The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (±0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (±38) mL/min. The total number of catheter days was 7451, with a mean of 133 days and a range of 46–322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively. Conclusion: Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology. Future research should further develop and confirm these initial findings.