Ultrasound-Guided Cannulation of the Femoral Vein for Acute Hemodialysis Access with Silicone Catheters

Experience with the use of uncuffed double-lumen silicone hemodialysis catheters

Aim

This study aimed to describe our experience with the use of uncuffed double-lumen silicone hemodialysis catheters (USHDCs) that were used in 54 cases as a temporary vascular access (VA). Subjects and methods: We recorded, retrospectively, all the USHDCs (size 13.5 French (F), length 15, 20 and 24 cm) that were inserted in our dialysis unit from July 2003 to September 2004. Catheter and patient characteristics, as well as catheter related complications, were recorded.

Results

There were 88 catheters used in 54 cases (44 patients). The catheters remained in place for a total of 2537 days (range 8–127 days, mean 46.9 ± 31.1). For catheter placement, the internal jugular veins (group A) or the femoral veins (group B) were used in a non-randomized manner. In group A, in 17 cases, 31 catheters were used for a total of 1169 days (mean 68.7 ± 28.5), while in group B, in 37 cases, 57 catheters were used for a total of 1368 days (mean 36.9 ± 27.1; p<0.001). In group B, 81% of cases (30/37) were ambulatory from the time of insertion. Mean urea reduction ratio (URR) in well functioning catheters (blood flow ≥200 ml/min) was 65.5 ± 4.6% in group A and 56.9 ± 6.2% in group B; p<0.001. Catheter-related bacteremia was observed in five group A cases and in seven group B cases (p=ns). Three cases of minor bleeding at the insertion site and three cases of ipsilateral leg edema were recorded in group B patients. In group A, only one case of bleeding at the insertion site was recorded.

Conclusion

Uncuffed double-lumen silicone hemodialysis catheters (USHDCs), 13.5 F in size, provided a very efficient temporary VA when placed in the jugular vein. Femoral placement of these catheters can also be used successfully in non bed-ridden patients, but delivering a lower dialysis dose.

Continuous venovenous hemofiltration combined with hemoperfusion for toxic epidermal necrolysis: a retrospective cohort study

AIM

The current treatments of toxic epidermal necrolysis (TEN) are limited to the discontinuation of a suspect medication and supportive measures. We conducted a retrospective study to evaluate the efficacy of adding continuous venovenous hemofiltration (CVVH) and hemoperfusion (HP) to the conventional treatment for TEN.

METHODS

TEN patients who were admitted to our center between January 2008 and May 2016 were considered as candidates. The included patients were divided into the CVVH&HP group (n = 34) and the conventional group (n = 34) according to their accepted therapies during hospital stay.

RESULTS

The patients in the conventional group had a significantly reduced 28-day survival proportion compared with patients in the CVVH&HP group (73.5 versus 91.2%, p = .047). The adjusted results demonstrated that the conventional group had a significantly higher risk of 28-day mortality as well. Moreover, patients in the CVVH&HP group were associated with significantly shorter hospital stay, rash, fever, and antibiotic durations. However, the addition of CVVH&HP to conventional treatment did not significantly increase the in-hospital cost.

CONCLUSIONS

In conclusion, CVVH&HP might be a safe and effective adjuvant therapy for TEN. Further well-designed studies are warranted to obtain robust evidence.

Placement of hemodialysis catheters with a technical, functional, and anatomical viewpoint

Aims. Vascular access is of prime importance for hemodialysis patients. We aimed to study early complications of hemodialysis catheters placed in different central veins in patients with acute or chronic renal failure with or without ultrasound (US ) guidance. Material and Methods. Patients who were admitted to our unit between March 2008 and December 2010 with need for vascular access have been included. 908 patients were examined for their demographic parameters, primary renal disease, and indication for catheterization, type and location of the catheter, implantation technique, and acute complications. Results. The mean age of the patients was 60.6 ± 16.0 years. 643 (70.8 %) of the catheters were temporary while 265 (29.2%) were permanent. 684 catheters were inserted to internal jugular veins, 213 to femoral, and 11 to subclavian veins. Arterial puncture occurred in 88 (9.7%) among which 13 had resultant subcutaneous hematoma. No patient had lung trauma and there had been no need for removal of the catheter or a surgical intervention for complications. US guidance in jugular vein and experience of operator decreased arterial puncture rate. Conclusion. US-guided replacement of catheter to internal jugular vein would decrease complication rate. Referral to invasive nephrologists may decrease use of subclavian vein. Experience improves complication rates even under US guidance.

Ultrasound-guided femoral dialysis access placement: a single-center randomized trial

BACKGROUND AND OBJECTIVES

Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmark-guided technique (ALT) for the femoral vein (FV).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.

RESULTS

Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P = 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P = 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P = 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).

CONCLUSIONS

USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.