Korsten Peter, Kuczera Tim, Wallbach Manuel, Tampe Björn
Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany.
J Clin Med. 2021 Sep 3;10(17):3999. doi: 10.3390/jcm10173999.
Chronic kidney disease (CKD) is a common medical problem in patients worldwide, with an increasing prevalence of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). In patients requiring RRT for more than two weeks or those who develop ESKD, tunneled hemodialysis catheter (HDC) insertion is preferred, based on a lower risk for infectious complications. While the efficacy of ultrasound (US)-guided tip positioning in antegrade-tunneled HDCs has previously been shown, its application for the insertion of retrograde-tunneled HDCs has not been described yet. This is especially important, since the retrograde-tunneled technique has several advantages over the antegrade-tunneled HDC insertion technique. Therefore, we here report our first experience of applying the rapid atrial swirl sign (RASS) for US-guided tip positioning of retrograde-tunneled HDCs.
We performed a cross-sectional study to assess the feasibility of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs. We performed a total number of 24 retrograde-tunneled HDC insertions in 23 patients (requiring placement of a HDC for the temporary or permanent treatment of ESKD) admitted to our Department of Nephrology and Rheumatology at the University Medical Center Göttingen, Germany.
The overall success rate of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs was 24/24 (100%), with proper tip position in the right atrium in 18/23 (78.3%), or cavoatrial junction in 5/23 (21.7%) when RASS was positive and improper position when RASS was negative in 1/1 (100%), confirmed by portable anterior-posterior chest radiography, with only minor post-procedural bleeding in 2/24 (8.3%). In addition, this insertion technique allows optimal HDC flow, without any observed malfunction.
This is the first study to investigate the efficacy of the RASS for US-guided tip positioning of retrograde-tunneled HDCs in patients with ESKD. Application of the RASS for US-guided tip positioning is an accurate and safe procedure for the proper placement of retrograde-tunneled HDCs.
慢性肾脏病（CKD）是全球患者中常见的医学问题，需要肾脏替代治疗（RRT）的终末期肾病（ESKD）患者患病率不断上升。对于需要RRT超过两周的患者或发生ESKD的患者，基于感染并发症风险较低，首选置入带隧道的血液透析导管（HDC）。虽然超声（US）引导下顺行带隧道HDC尖端定位的有效性此前已得到证实，但其在逆行带隧道HDC置入中的应用尚未见报道。这一点尤为重要，因为逆行带隧道技术相对于顺行带隧道HDC置入技术有几个优点。因此，我们在此报告应用快速心房涡旋征（RASS）进行超声引导下逆行带隧道HDC尖端定位的首次经验。
我们进行了一项横断面研究，以评估应用RASS进行超声引导下逆行带隧道HDC尖端定位的可行性。我们对德国哥廷根大学医学中心肾脏病与风湿病科收治的23例患者（需要置入HDC进行ESKD的临时或永久治疗）共进行了24次逆行带隧道HDC置入。
应用RASS进行超声引导下逆行带隧道HDC尖端定位的总体成功率为24/24（100%），RASS阳性时，18/23（78.3%）的导管尖端位置正确位于右心房，5/23（21.7%）位于腔房交界处，RASS阴性时1/1（100%）位置不正确，便携式前后位胸部X线片证实，仅2/24（8.3%）有轻微术后出血。此外，这种置入技术可使HDC血流最佳，未观察到任何故障。
这是第一项研究RASS在超声引导下对ESKD患者逆行带隧道HDC尖端定位有效性的研究。应用RASS进行超声引导下尖端定位是逆行带隧道HDC正确置入的准确且安全的方法。
