LAUSR

In patients with end-stage renal disease (ESRD), the use of cuffed, tunneled dialysis catheters (TDCs) 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. From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with ERDS who required TDC placement. 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 7,451, with a mean of 133 days and a range of 46 to 322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively. 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.