Centro de Nefrologia da Santa Casa de Belo Horizonte, R. Piauí, 420 - Santa Efigênia, Belo Horizonte, MG, 30150-320, Brazil.
J Nephrol. 2022 Jun;35(5):1515-1519. doi: 10.1007/s40620-022-01346-5. Epub 2022 May 14.
Hemodialysis is the most used dialysis modality in Brazil for the treatment of end-stage chronic kidney disease and severe acute kidney injury. Non-tunneled, short-term, double-lumen catheters allow immediate vascular access in patients without a definitive vascular access for dialysis treatment. Implantation is performed using the Seldinger technique, traditionally based on anatomical landmarks or with puncture under direct visualization by ultrasonography. Confirmation of the placement of the catheter is usually made with a chest X-ray after the end of the procedure.
To describe the use of ultrasonography to confirm the proper positioning of the guidewire during catheter implantation in real time, ensuring the desired path.
We used the Seldinger technique for catheter implantation. The confirmation of the position of the guidewire occurred after the introduction of 50 cm of this wire, as described in the aforementioned technique. A convex transducer was placed longitudinally below the xiphoid process to visualize the guidewire in the inferior vena cava, or transversely at the same location to visualize it in the cavoatrial junction or right ventricle, using the two-dimensional mode of the ultrasound device. After viewing the guidewire, the catheter implantation proceeded.
The technique was performed in 1549 patients, and regarded 2596 catheter implantations over a period of 5 years and 9 months. The only complication observed was local hematoma, occurring in 0.1% of cases.
Confirmation of guidewire position with ultrasonography during catheter implantation is recommended because it is safe, low cost and ensures correct catheter direction.
血液透析是巴西治疗终末期慢性肾脏病和严重急性肾损伤最常用的透析方式。无隧道、短期、双腔导管允许在没有用于透析治疗的永久性血管通路的患者中立即获得血管通路。植入是使用 Seldinger 技术进行的，传统上基于解剖学标志，或在超声引导下直接进行穿刺。在手术结束后，通常通过胸部 X 光片确认导管的位置。
描述在导管植入过程中使用超声实时确认导丝的正确位置，以确保达到预期的路径。
我们使用 Seldinger 技术进行导管植入。导丝位置的确认是在引入 50 厘米导丝后进行的，如上述技术所述。将凸面换能器纵向放置在剑突下方，以在腔静脉中可视化导丝，或在同一位置横向放置，以在腔静脉与心房交界处或右心室中可视化导丝，使用超声设备的二维模式。在观察导丝后，继续进行导管植入。
该技术在 1549 名患者中进行，在 5 年 9 个月的时间内进行了 2596 次导管植入。观察到的唯一并发症是局部血肿，发生率为 0.1%。
建议在导管植入过程中使用超声确认导丝位置，因为它安全、成本低，并能确保导管的正确方向。
