Department of Nephrology, Global Hospitals, Andhra Pradesh, India.
Clin J Am Soc Nephrol. 2010 Feb;5(2):235-9. doi: 10.2215/CJN.04920709. Epub 2009 Dec 3.
Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmark-guided technique (ALT) for the femoral vein (FV).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.
Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P = 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P = 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P = 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).
USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.
插入透析导管(DC)是成功开始血液透析的前提。我们试图确定超声引导(USG)插入是否优于和更安全比解剖标志引导技术(ALT)股静脉(FV)。
设计、设置、参与者和测量:这是一项在三级保健医院需要 FV DC 的 110 例患者的随机前瞻性研究。患者随机分为两组:USG 和 ALT。收集数据包括人口统计学、操作人员经验和插入侧。USG 组在 USG 引导下插入导管,而 ALT 组通过 ALT 插入 DC。结果测量包括 DC 成功插入、尝试次数和并发症。
两组在患者年龄和性别、操作人员经验和导管化侧方面具有可比性。总体成功率为 89.1%,ALT 组为 80%,USG 组为 98.2%(P=0.002)。ALT 组首次尝试成功率为 54.5%,USG 组为 85.5%(P=0.000)。ALT 组并发症发生率为 18.2%,USG 组为 5.5%(P=0.039)。两次或更多次尝试的并发症的优势比(OR)为 10.73,相对风险(RR)为 3.2。USG 用于成功插入的 OR 为 13.5(95%CI:1.7 至 108.7)。
USG 显著提高了成功率,减少了尝试次数,并降低了与 FV DC 插入相关的并发症发生率。