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
1 Nephrology and Critical Care Department, Hospital Portugues, Salvador, Brazil.
2 Critical Care Department, Hospital São Rafael, Salvador, Brazil.
J Vasc Access. 2019 Jul;20(4):362-367. doi: 10.1177/1129729818806121. Epub 2018 Oct 25.
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.
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.
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.
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.
在终末期肾病患者中，带 cuff 的隧道式透析导管用于血液透析已成为治疗方案的重要组成部分。荧光透视法是一种广泛接受的带 cuff 透析导管插入和定位方法，因为它易于使用、准确可靠，且并发症发生率相对较低。我们研究的目的是评估不使用荧光透视法但采用基于动态超声成像引导技术进行隧道式血液透析导管置入的可行性。
2015 年 1 月至 2017 年 12 月，我们对 56 例需要置入隧道式透析导管的终末期肾病患者进行了一项观察性前瞻性队列研究。
超声引导下中心静脉通路的总体成功率为 100%，每位患者平均尝试次数为 1.16（±0.4）次。没有出现导丝盘绕/扭结、颈动脉穿刺、气胸或导管故障的情况。透析期间导管血流量为 286（±38）mL/分钟。导管使用天数总计 7451 天，平均 133 天，范围为 46 - 322 天。生存表分析显示，在 30、60 和 120 天时的首次通畅率分别为 100%、96%和 53%。
基于动态超声对右心房微气泡的可视化是一种无需荧光透视引导技术即可检测大腔、隧道式中心静脉导管经皮植入的高度准确方法。未来研究应进一步发展并证实这些初步发现。
