Konnepati Sushma, Sethi Jasmine, Lal Anupam, Ramachandran Raja, Rathi Manish
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nephrol. 2024 Jul-Aug;34(4):363-368. doi: 10.25259/ijn_414_23. Epub 2024 Jun 4.
Fluoroscopy is considered to be the gold standard and an essential requirement for catheter insertion. However, there is a paucity of data regarding the outcomes in ultrasound (USG)-guided insertion with and without fluoroscopy. We compared the complications of USG-guided tunneled dialysis catheter (TDC) insertion with and without fluoroscopy assistance.
This was a single-center randomized controlled trial (RCT) done in a tertiary hospital in North India. After screening 153 patients, 149 were enrolled: 87 were randomized into USG-guided insertion without fluoroscopy (group A) and 62 were randomized into USG-guided insertion with fluoroscopy (group B). All insertions were done in a dedicated procedure room by trained nephrologists. Outcomes were analyzed at baseline and at 1-month follow-up. Mechanical complications as well as infective and thrombotic complications were compared between both the groups.
TDC insertion was successful (100%) in all the study participants ( = 149). One hundred twenty-nine catheters (86.5%) were inserted in the first attempt, 19 (12.5%) in the second attempt, and one catheter insertion required three attempts for insertion. The mean age of study participants was 43 years (±16.5), and males constituted 63% of the study cohort. Baseline laboratory characteristics of the two groups were comparable. The mean time of catheter insertion was 41.26 min (standard deviation [SD] 11.8) in group A and 47.74 min (SD 17.2) in group B ( = 0.007). The mean score of ease of catheter insertion, exit site bleed, infective and mechanical complications were not different between the two groups.
Our study concluded that fluoroscopy has no additional advantage in reducing mechanical, infective, or thrombotic complications. In experienced hands, USG-guided TDC insertion without fluoroscopy assistance is as good as the insertion done with fluoroscopy assistance, with a shorter procedure time.
荧光透视检查被认为是导管插入的金标准和基本要求。然而，关于超声（USG）引导下有无荧光透视检查的插入结果的数据却很少。我们比较了在有和没有荧光透视辅助的情况下，USG引导下隧道式透析导管（TDC）插入的并发症。
这是一项在印度北部一家三级医院进行的单中心随机对照试验（RCT）。在筛选了153名患者后，149名患者被纳入研究：87名被随机分配到无荧光透视的USG引导插入组（A组），62名被随机分配到有荧光透视的USG引导插入组（B组）。所有插入操作均由训练有素的肾病学家在专门的操作室进行。在基线和1个月随访时分析结果。比较两组之间的机械并发症以及感染性和血栓形成性并发症。
所有研究参与者（n = 149）的TDC插入均成功（100%）。129根导管（86.5%）在首次尝试时插入，19根（12.5%）在第二次尝试时插入，1根导管插入需要三次尝试。研究参与者的平均年龄为43岁（±16.5），男性占研究队列的63%。两组的基线实验室特征具有可比性。A组导管插入的平均时间为41.26分钟（标准差[SD] 为11.8），B组为47.74分钟（SD为17.2）（P = 0.007）。两组之间导管插入的难易程度、出口部位出血、感染性和机械并发症的平均评分没有差异。
我们的研究得出结论，荧光透视检查在减少机械、感染或血栓形成并发症方面没有额外优势。在经验丰富的医生手中，无荧光透视辅助的USG引导下TDC插入与有荧光透视辅助的插入效果一样好，且操作时间更短。
