Division of Nephrology, Department of Medicine, National University Health System, Singapore, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.
J Vasc Access. 2022 May;23(3):443-449. doi: 10.1177/11297298211000872. Epub 2021 Mar 12.
BACKGROUND/OBJECTIVE: To study the safety and outcome profiles of tunnelled dialysis catheter (TDC) insertions and exchanges with fluoroscopy versus without fluoroscopy.
This was a retrospective cohort study of all TDC insertions or exchanges performed at our centre, between January 2017 and December 2017. Patient demographics, laboratory results and catheter placement information were obtained from electronic records. Immediate technical success, early and late catheter associated complications were collected. Outcomes for TDC inserted with or without fluoroscopy were statistically analysed.
A total of 351 TDC insertions and 253 TDC exchanges were performed. Out of 351 TDC insertions, 261 were done with fluoroscopy while 90 were done without. Out of 253 TDC exchanges, 219 were done with fluoroscopy while 34 were done without. For both TDC insertions and exchanges, there were no significant differences in complication rates when done with or without fluoroscopy. Mean duration of catheter patency was longer for TDC inserted without fluoroscopy, after adjusting for site of insertion and presence of previous TDC.
The technique of inserting TDC in the right internal jugular vein (IJV) without fluoroscopy is a safe and effective method in selected patients. This supports the practice of performing the procedure without fluoroscopy, especially in institutions where fluoroscopy facilities are not readily available. This potentially translates into reduced healthcare resources and hospitalisation days, which is particularly valuable in times of limited resources such as the current Coronavirus Disease 2019 (COVID-19) pandemic.
背景/目的：研究在透视引导下与非透视引导下行隧道式透析导管（TDC）置管和更换的安全性和结果特征。
这是一项回顾性队列研究，纳入了 2017 年 1 月至 2017 年 12 月在我们中心进行的所有 TDC 置管或更换。从电子病历中获取患者人口统计学、实验室结果和导管放置信息。收集即时技术成功率、早期和晚期导管相关并发症。统计分析有和无透视引导下 TDC 置管的结果。
共进行了 351 次 TDC 置管和 253 次 TDC 更换。351 次 TDC 置管中，有 261 次在透视引导下进行，90 次在无透视引导下进行。253 次 TDC 更换中，有 219 次在透视引导下进行，34 次在无透视引导下进行。在 TDC 置管和更换中，无论是否进行透视引导，并发症发生率均无显著差异。在调整了置管部位和是否存在先前 TDC 后，无透视引导下 TDC 的通畅时间更长。
在选定的患者中，在右颈内静脉（IJV）中无透视引导下置管 TDC 是一种安全有效的方法。这支持在没有透视引导的情况下进行该操作，特别是在没有透视设备的医疗机构。这可能会减少医疗资源和住院天数，这在资源有限的时期（如当前的 2019 年冠状病毒病（COVID-19）大流行）特别有价值。
