Value of Ultrasound Guidance in Placement of Hemodialysis Access Catheters in Patients with End-Stage Renal Disease

2008 ◽  
Vol 74 (11) ◽  
pp. 1111-1113
Author(s):  
Chandra Hassan ◽  
H.T. Girishkumar ◽  
Bala Thatigotla ◽  
Muhammad Asad ◽  
Mahalingam Sivakumar ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Jugular Vein ◽  
Venous Occlusion ◽  
Central Vein ◽  
Ultrasound Guided ◽  
Hemodialysis Catheter ◽  
Ultrasound Assessment ◽  
Stage Renal Disease ◽  
End Stage

The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. All patients underwent perioperative ultrasound assessment of the venous access site, followed by fluoroscopic confirmation of the catheter placement. Data from medical charts and the hospital computer system were subjected to statistical analysis. A total of 126 patients underwent ultrasound-guided placement of a hemodialysis catheter in a central vein; 58 had undergone prior placement of a central vein catheter, but 69 had not. Patients in the later group had a 100 per cent success rate in catheter placement after ultrasound assessment of one central vein. Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded central veins. This protocol is effective and improves patient safety.

Post-procedural pseudoaneurysms: Single-center experience

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Farah Mohammad ◽  
Loay Kabbani ◽  
Judith Lin ◽  
Efstathios Karamanos ◽  
Fatema Esmael ◽  
...  
Keyword(s):  
Renal Disease ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
End Stage Renal Disease ◽  
Odds Ratio ◽  
Thrombin Injection ◽  
Ultrasound Guided ◽  
Post Procedure ◽  
Stage Renal Disease ◽  
End Stage

Objectives Pseudoaneurysms are a well-recognized complication of percutaneous angiographic procedures. Ultrasound-guided thrombin injection is currently the preferred treatment modality. This study was undertaken to evaluate our experience with the management of post-procedure pseudoaneurysms. Methods A retrospective study was undertaken of all patients who developed a post-procedure pseudoaneurysm between March 2004 and January 2013. Data were obtained from our prospectively maintained non-invasive vascular laboratory data base. Results Overall, 167 patients (80 men) with post-procedure pseudoaneurysms were identified. The mean age was 66 years. Post-procedure pseudoaneurysms developed following diagnostic coronary angiography (38%), coronary angioplasty (37%), peripheral vascular interventions (14.7%), or other access procedures (7.6%). Mean post-procedure pseudoaneurysm diameter was 2.8 ± 1.8 cm. One hundred forty-two post-procedure pseudoaneurysms were injected with thrombin under ultrasound guidance. Primary success rate was 93.5%. There were 12 (8.5%) procedural failures of which seven (58%) responded to reinjection, three (25%) required operative management, one was treated with ultrasound-guided compression, and one (8.3%) was simply observed. On multivariate analysis, failures were associated with increased aneurysm diameter ( p = 0.006; odds ratio 2.23, 95% CI 1.25 to 3.96), end-stage renal disease ( p = 0.013; odds ratio 1.15, 95% CI 1.09 to 1.78) and superficial femoral artery aneurysm origin ( p = 0.031; odds ratio 0.20, 95% CI 0.04 to 0.86). There were two episodes of thrombus formation in the femoral artery; one resolved with anticoagulation alone, and the other required thrombectomy. Conclusions Percutaneous ultrasound-guided thrombin injection is an effective and safe method for managing post-procedure pseudoaneurysms. Failure rates are low and associated with large aneurysm size, superficial femoral artery origin and end-stage renal disease.

scholarly journals Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system

2021 ◽  
Author(s):  
Nicholas S. Roetker ◽  
Haifeng Guo ◽  
Marquita Decker-Palmer ◽  
Yi Peng ◽  
James Wetmore
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Piecewise Linear ◽  
Prospective Payment System ◽  
Payment System ◽  
Prospective Payment ◽  
Hemodialysis Catheter ◽  
Fibrin Sheath ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients. Methods: Using quarterly, period prevalent cohorts of patients undergoing maintenance HD with a catheter in the US Renal Data System (2008-2015), we studied rates of claims for within- and outside-HD-unit thrombolytic use, and thrombus/fibrin sheath removal, and rates of delayed HD treatment after ESRD PPS implementation, January 1, 2011. Associations between PPS implementation and change in trend of rates of each outcome were assessed using covariate-adjusted Poisson regression, using a piecewise linear function for quarter-time (with breakpoint at PPS implementation). Results: Among an average of 69,428 quarterly catheter users, rates of claims for within-HD-unit thrombolytic use declined from 236.6 (Q1-2008) to 81.4 (Q4-2012) per 100 person-years ( P < 0.0001, PPS association with change in trend); rates of claims for thrombus/fibrin sheath removal procedures increased from 3.9 (Q1-2008) to 8.8 (Q3-2015) per 100 person-years ( P = 0.0001, PPS association with change in trend). Rates of delayed HD treatment increased from 1.6 (Q2-2008) to 2.3 (Q3-2015) per patient-quarter, although PPS implementation was associated with a decrease in this rising trend (1.6% increase per quarter pre-PPS, 1.2% post-PPS; P < 0.0001, change in trend). Conclusions: After PPS implementation, thrombolytic use decreased and thrombus/fibrin sheath removal increased. The increasing trend in delayed HD treatment appeared to slow after PPS implementation, but delayed sessions continued to increase year over year for unclear reasons.

scholarly journals Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system

2020 ◽  
Author(s):  
Nicholas S. Roetker ◽  
Haifeng Guo ◽  
Marquita Decker-Palmer ◽  
Yi Peng ◽  
Jamaes Wetmore
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Piecewise Linear ◽  
Prospective Payment System ◽  
Payment System ◽  
Prospective Payment ◽  
Hemodialysis Catheter ◽  
Fibrin Sheath ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients. Methods Using quarterly, period prevalent cohorts of patients undergoing maintenance HD with a catheter in the US Renal Data System (2008–2015), we studied rates of claims for within- and outside-HD-unit thrombolytic use, and thrombus/fibrin sheath removal, and rates of delayed HD treatment after ESRD PPS implementation, January 1, 2011. Associations between PPS implementation and change in trend of rates of each outcome were assessed using covariate-adjusted Poisson regression, using a piecewise linear function for quarter-time (with breakpoint at PPS implementation). Results Among an average of 69,428 quarterly catheter users, rates of claims for within-HD-unit thrombolytic use declined from 236.6 (Q1-2008) to 81.4 (Q4-2012) per 100 person-years (P < 0.0001, PPS association with change in trend); rates of claims for thrombus/fibrin sheath removal procedures increased from 3.9 (Q1-2008) to 8.8 (Q3-2015) per 100 person-years (P = 0.0001, PPS association with change in trend). Rates of delayed HD treatment increased from 1.6 (Q2-2008) to 2.3 (Q3-2015) per patient-quarter, although PPS implementation was associated with a decrease in this rising trend (1.6% increase per quarter pre-PPS, 1.2% post-PPS; P < 0.0001, change in trend). Conclusions After PPS implementation, thrombolytic use decreased and thrombus/fibrin sheath removal increased. The increasing trend in delayed HD treatment appeared to slow after PPS implementation, but delayed sessions continued to increase year over year for unclear reasons.

scholarly journals An institutional experience in insertion of hemodialysis catheter and peritoneal dialysis catheter for children with end stage renal disease

2019 ◽  
Vol 6 (5) ◽  
pp. 1802
Author(s):  
Anit Joseph K. ◽  
Vivek P. Sarma ◽  
Aravind C. S. ◽  
Sethunath S. ◽  
Sivakumar K. ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Image Guidance ◽  
Catheter Insertion ◽  
Dialysis Catheter ◽  
Hemodialysis Catheter ◽  
Stage Renal Disease ◽  
Operative Notes ◽  
End Stage

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

Studying alternative approaches for placement of cuffed hemodialysis catheters in hemodialysis patients with bilateral internal jugular vein occlusion

2018 ◽  
Vol 20 (3) ◽  
pp. 250-259 ◽  
Author(s):  
Zaghloul Elsafy Gouda ◽  
Mahmoud Mohamed Emara ◽  
Hany Said Elbarbary ◽  
Mahmoud Abdel Aziz Koura ◽  
Ahmed Rabie Elarbagy
Keyword(s):  
Renal Disease ◽  
Internal Jugular Vein ◽  
End Stage Renal Disease ◽  
Jugular Vein ◽  
Femoral Vein ◽  
Vena Cava ◽  
Vein Occlusion ◽  
Alternative Approaches ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view. Method: The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion. Ultrasound Doppler guided catheter insertion was used as a routine practice in addition to fluoroscopy or post insertion X-ray to localize catheter tip position and exclude complications. Follow-up of patients was conducted until the end of the study or catheter removal. Findings: The most highly prevalent alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%), and finally the retrograde femoral vein approach (1.49%). Discussion: End-stage renal disease patients maintained on regular hemodialysis who have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft is a daily scenario in nephrology practice. Our study showed that there is a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins. Interventional nephrologists have a major role in solving the problem of poor hemodialysis vascular access. These alternative approaches can conserve the anatomically limited number of percutaneous access sites in each patient.

An unusual case of an irretrievable hemodialysis catheter in a patient with end stage renal disease

2017 ◽  
Vol 22 (1) ◽  
pp. E1-E5 ◽  
Author(s):  
Mehrdad Ghahremani-Ghajar ◽  
Anna Jin ◽  
Peyman Borghei ◽  
Joline L. T. Chen
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Unusual Case ◽  
Hemodialysis Catheter ◽  
Stage Renal Disease ◽  
End Stage
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