Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
Arch Ital Urol Androl. 2023 Sep 27;95(3):11588. doi: 10.4081/aiua.2023.11588.
To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients.
This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk.
All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion.
Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion.
指出我们的经验，并评估实时超声引导下中心内颈静脉（IJV）置管术在血液透析患者中的疗效和安全性。
本回顾性研究纳入了 2019 年 3 月至 2021 年 3 月期间在我院接受实时超声（US）引导下 IJV 血液透析置管的 150 例终末期肾病（ESRD）患者。检查患者的人口统计学数据、病因、置管部位、肾衰竭类型（急性或慢性）、技术成功率、手术时间、穿刺针数和与操作相关的并发症。具有多次置管史、既往置管困难、依从性差、肥胖、骨畸形和凝血障碍的患者被认为具有高手术风险。
所有患者均获得技术成功。在患者临床特征方面，正常风险组和高风险组之间无显著差异（p 值>0.05）。150 个导管中，62 个（41.3%）置于高风险患者中。正常风险组首次尝试成功率为 89.8%，高风险组为 72.5%（p=0.006）。正常风险组的 IJV 置管时间明显短于高风险组（21.2±0.09）分钟比（35.4±0.11）分钟，（p<0.001）。无严重并发症。在颈内静脉置管过程中，高风险组有 4 例（6.4%）患者出现动脉穿刺。两组各有 2 名患者出现小颈部血肿。高风险组 1 例发生气胸，经肋间胸腔引流管插入治疗。
即使在高风险组中，实时 US 引导下 IJV 中心导管置入术的并发症发生率低，成功率高。即使在 US 引导下，经验也能降低并发症发生率。建议在中心静脉置管过程中常规使用实时 US 引导。
