Cho Seong, Lee Yu-Ji, Kim Sung-Rok
Division of Nephrology, Department of Internal Medicine, College of Medicine, The Sungkyunkwan University of Korea; Samsung Changwon Hospital, Changwon - Korea.
J Vasc Access. 2015 Jul-Aug;16(4):285-8. doi: 10.5301/jva.5000378. Epub 2015 Mar 18.
Recently, there have been many reports that exact central vein catheter tip positioning was possible using intracardiac electrocardiographic (ECG) monitoring. Ultrasonic guidance in combination with intracardiac ECG monitoring may allow for a tunneled dialysis catheter to be inserted at the bedside without using fluoroscopy. Therefore we report on the intracavitary ECG method for insertion of a tunneled dialysis catheter with ultrasound guidance and the feasibility, safety, effectiveness, complications and limitations of this method.
From April 2012 to June 2014, we evaluated 142 hemodialysis (HD) patients who were dialyzed by a tunneled dialysis catheter that was inserted using intracardiac ECG monitoring without fluoroscopic usage. We checked the intracardiac P wave and the point at which it gradually rose to the highest P wave morphology, we stopped inserting the catheter.
Catheter flow during dialysis was adequate in 139 cases. There were three cases where it malfunctioned. Catheter malposition occurred in 6 out of 142 cases. The correct matching rate between the intracardiac ECG and chest posteroanterior (PA) view was 98.5%. No significant complications developed.
To conclude, in this single-center study, the intracavitary ECG method for assessing the position of the tip of tunneled dialysis catheter was proven to be safe and feasible in virtually all adult patients who had an evident P wave at the basal ECG tracking.
最近，有许多报道称使用心内心电图（ECG）监测能够实现精确的中心静脉导管尖端定位。超声引导结合心内心电图监测可使带隧道涤纶套透析导管在床边插入，而无需使用荧光透视。因此，我们报告了在超声引导下使用心腔内心电图方法插入带隧道涤纶套透析导管的情况，以及该方法的可行性、安全性、有效性、并发症和局限性。
2012年4月至2014年6月，我们评估了142例接受血液透析（HD）的患者，这些患者通过使用心内心电图监测插入的带隧道涤纶套透析导管进行透析，未使用荧光透视。我们检查心腔内P波以及其逐渐上升至最高P波形态的点，然后停止插入导管。
139例患者透析期间导管血流量充足。有3例出现功能故障。142例中有6例发生导管位置不当。心内心电图与胸部后前位（PA）视图的正确匹配率为98.5%。未出现明显并发症。
总之，在这项单中心研究中，对于几乎所有基础心电图追踪时有明显P波的成年患者，评估带隧道涤纶套透析导管尖端位置的心腔内心电图方法被证明是安全可行的。
