Abstract: FR-PO536
Bedside Ultrasound (US)-Guided Nonfluoroscopic Insertion of Right-Sided Tunneled Dialysis Catheter: Largest Experience from a Single Center
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Khandelwal, Sejal, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Tassillo, Audrey, Niagara Health System, St. Catharines, Ontario, Canada
- Khandelwal, Mukesh, Niagara Health System, St. Catharines, Ontario, Canada
Background
Tunneled dialysis cuffed catheters (TDCs) are often used for initial access in crash start and other hemodialysis (HD) patients due to lack of arteriovenous fistulae. While the NKF-KDIGO guidelines recommends fluoroscopic-guided TDC insertion by interventional radiology (IR) as the standard of care, there is a growing body of evidence supporting the safety, efficacy, and promptness of bedside ultrasound (US)-guided nonfluoroscopic TDC insertion. This study aims to evaluate the feasibility and safety of bedside US-guided TDC insertion by a nephrologist.
Methods
A comprehensive retrospective chart review of patients who underwent bedside TDC insertion at Niagara Health from 2011-2024 was conducted. Patients were identified from office electronic medical records (EMR) using the provincial billing code for TDC insertion.
Inclusion criteria comprised a patent right internal jugular (RIJ) vein, INR<1.5, absence of anticoagulation at the time of insertion, and the ability to assume a supine or at least 30° upright position. Exclusion criteria encompassed patients with right-sided pacemakers or AICDs, severe coagulopathy, active sepsis, an occluded RIJ vein, or known superior vena cava stenosis.
Results
A total of 901 catheters were inserted in 867 patients by one nephrologist. Four patients were unsuccessful due to guidewire negotiation issues and necessitated IR intervention. Catheter tip position was confirmed by nephrologist and chest x-ray. Catheter tip was in the right ventricle in two cases, and one patient had azygos vein placement. In one patient with a right-sided pacemaker, left-sided TDC was attempted, but catheter tip ended in right IJV and required repositioning by IR.
Complications include occasional premature ventricular contractions, one hyperkalemia-induced cardiac arrest with successful resuscitation, catheter kinking in 2 cases, and minor bleeding in 12 cases. Additionally, two cases with very high BMI (> 700 lbs) that were deemed unsuitable by IR underwent successful bedside insertion. Furthermore, another case with a right-sided pacemaker had successful insertion of a right TDC, after cardiology approval.
Conclusion
US-guided bedside TDC insertion by nephrologists is highly successful and safe, offering a viable alternative to fluoroscopic-guided insertion.