ULTRASOUND GUIDED TUNNELLED CUFFED CATHETER PLACEMENT WITHOUT FLUOROSCOPIC GUIDANCE BY ANATOMICAL LANDMARKS; ACCURACY AND SAFETY

Authors

  • Wahaj Wahaj Pak Emirates Military Hospital Rawalpindi
  • Malik Nadeem Azam Pak Emirates Military Hospital, Rawalpindi.
  • Batool Butt Pak Emirates Military Hospital, Rawalpindi.
  • Salahuddin Salahuddin Pak Emirates Military Hospital, Rawalpindi.
  • Taleah Tahir Pak Emirates Military Hospital, Rawalpindi.
  • Nudrat Jehangir Khan Pak Emirates Military Hospital, Rawalpindi.
  • Muhammad Khalid Rahman Pak Emirates Military Hospital, Rawalpindi.
  • Khalid Mehmood Raja Pak Emirates Military Hospital, Rawalpindi.
  • Abdul Rehman Arshad Pak Emirates Military Hospital, Rawalpindi.
  • Abdul Wahab Mir Pak Emirates Military Hospital, Rawalpindi.

Abstract

Background: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). TCC placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings. Methods: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure. Results: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001). Conclusion: TCC can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance.Keywords: Chronic Kidney Disease; Haemodialysis; Central Venous Catheter; Tunnelled Cuffed Catheter; Anatomical Landmarks; Carina; Fluoroscopy; Chest Radiograph

Author Biographies

Wahaj Wahaj, Pak Emirates Military Hospital Rawalpindi

Registrar Nephrology in Department of Nephrology

Malik Nadeem Azam, Pak Emirates Military Hospital, Rawalpindi.

Col Dr Malik Nadeem AzamFCPS(Med), FCPS(Neph)Professor of Medicine, Army Medical College Rawalpindi,Classified Medical Splt & Classified Nephrologist. 

Batool Butt, Pak Emirates Military Hospital, Rawalpindi.

FCPS(Med), FCPS(Neph)Senior Registrar Department of Nephrology.

Salahuddin Salahuddin, Pak Emirates Military Hospital, Rawalpindi.

Registrar Nephrology in Department of Nephrology

Taleah Tahir, Pak Emirates Military Hospital, Rawalpindi.

Registrar Nephrology in Department of Nephrology

Nudrat Jehangir Khan, Pak Emirates Military Hospital, Rawalpindi.

Registrar Dermatology in Deparment of Dermatology.

Muhammad Khalid Rahman, Pak Emirates Military Hospital, Rawalpindi.

Brig Dr Muhammad Khalid RahmanFCPS(Med)HOD and Advisor in Nephrology

Khalid Mehmood Raja, Pak Emirates Military Hospital, Rawalpindi.

Col Dr Khalid Mehmood RajaMD-Med(US), MD-Neph(US)Professor of Medicine, Army Medical College Rawalpindi,Classified Medical Splt & Classified Nephrologist.

Abdul Rehman Arshad, Pak Emirates Military Hospital, Rawalpindi.

Lt Col Dr Abdul Rehman ArshadFCPS(Med), FCPS(Neph)Asst Professor of Medicine, Army Medical College Rawalpindi,Classified Medical Splt & Classified Nephrologist. 

Abdul Wahab Mir, Pak Emirates Military Hospital, Rawalpindi.

FCPS(Med)Registrar in Nephrology.

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Published

2019-11-06

Issue

Vol. 31 No. 4 (2019): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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