Clin Nephrol. 2020 Nov;94(5):237-244. doi: 10.5414/CN110076.
The implantation of acute or chronic vascular accesses for hemodialysis (HD) in end-stage kidney disease patients is a critical skill procedure for nephrologists, with an impact on short- and long-term outcomes of the modality and patient survival. Placement circumstances, however, may depend on the availability of technological support and will likely vary across the world.
We retrospectively reviewed our local experience with ultrasound-guided tunneled dialysis catheter (TDC) insertions but without access to fluoroscopic guidance. Data were available for 63 patients with TDCs placed by faculty nephrologists at the dialysis unit procedure rooms between March 2015 and February 2018. We reviewed circumstances of TDC placement, patient characteristics, and procedural outcomes.
The mean age was 62 (± 41) years, and 46% of the patients were male. All TDC placements were technically successful and no major complications occurred. Most TDCs (52.8%) were a de novo placement. In the de novo patient group, there were 27 right-sided internal jugular vein (IJV) and 6 left-sided IJV cannulations. Blood pump flow was 284.6 (± 58) mL/min via the temporary catheter 1 month before and 316.7 (± 46) mL/min 1 month after TDC placement (p < 0.0001). The majority of catheter tips (63%) reached the right atrial placement position successfully.
Technologically successful TDC placement can be performed without fluoroscopic tip guidance and result in improved access flows and dialysis efficacy when compared to temporary hemodialysis catheters.
在终末期肾病患者中植入急性或慢性血管通路（血液透析）是肾脏病专家的一项关键技能操作，对该治疗模式的短期和长期效果以及患者的生存都有影响。然而，置管环境可能取决于技术支持的可用性，并且在全球范围内可能会有所不同。
我们回顾性分析了 2015 年 3 月至 2018 年 2 月在透析单位治疗室由肾脏病专家进行的超声引导下隧道式透析导管（TDC）置管但没有使用透视引导的本地经验。我们回顾了 TDC 置管的情况、患者特征和手术结果。
患者的平均年龄为 62（±41）岁，46%为男性。所有 TDC 置管均技术上成功，无重大并发症发生。大多数 TDC（52.8%）是新置管。在新置管患者组中，有 27 例右侧颈内静脉（IJV）和 6 例左侧 IJV 置管。在 TDC 置管前 1 个月，临时导管的血液泵流量为 284.6（±58）mL/min，在 TDC 置管后 1 个月为 316.7（±46）mL/min（p < 0.0001）。大多数导管尖端（63%）成功到达右心房置管位置。
在没有透视尖端引导的情况下，技术上成功的 TDC 置管可以实现，与临时血液透析导管相比，可以提高血管通路流量和透析效果。
