Choosing the Right Strategy for Haemodialysis Central Venous Catheter Placement: A Retrospective Study OC05-OC08
Dr. Vishal Singh,
7 AF Hospital, Nathu Singh Road, Kanpur Cantt-208004, Uttar Pradesh, India.
Introduction: Vascular access is the ‘Achilles heel’ for patients requiring haemodialysis. The gold standard for vascular access is an Arteriovenous Fistula (AVF). In clinical practice, situations mandating the use of Central Venous Catheters (CVCs) are often encountered. The successful outcome for CVC placement depends on variables like operator experience and use of aids like ultrasonography and fluoroscopy.
Aim: To determine the difficulty level, outcome, and safety profile of the various prevalent modalities of CVC placement.
Materials and Methods: A total of 243, Internal Jugular Vein (IJV), CVC were placed during the study period. Depending on the availability and the clinical circumstances, various techniques including landmark guidance (n=99), ultrasound guidance (n=108) and ultrasound plus fluoroscopic guidance (n=36) were used. The data were retrospectively analysed with regards to the difficulty level and the safety profile. The surrogate marker for assessment of difficulty level included the number of passes required for successful cannulation and technique failure. The safety profile was assessed using procedure-related complication. The binomial outcome was assessed using Fisher’s-exact test.
Results: The rate of successful first-pass IJV cannulation in the landmark guided arm was 75% which improved to 92% by the second pass. The use of ultrasound guidance significantly improved the rate of first pass successful cannulation to 97.2%. Technique failure requiring the use of an alternative venous sites was noted in 6.1% of patients in the landmark guided arm. The common procedure related complication included local haematoma formation and carotid artery puncture. Compared to the landmark technique, the incidence of carotid artery puncture was significantly lower in the ultrasound guided arm.
Conclusion: In a resource poor environment, the use of landmark guided cannulation by a trained operator continues to be a safe procedure. The use of fluoroscopy and ultrasound, if available, is the gold standard. It improves the outcome while reducing procedure related complications.