Utilidad de la ecografía para la cateterización venosa central en pacientes en hemodiálisis periódica

Juan M. Fernández Cean; Sergio Orihuela; Enriqueta Carbonell

Authors

Juan M. Fernández Cean Nefrólogo
Sergio Orihuela Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Centro de Nefrología, Prof. Adj.
Enriqueta Carbonell Nefróloga

Keywords:

CENTRAL VENOUS CATHETERIZATION, HEMODIALYSIS, ULTRASONOGRAPHY

Abstract

Background. Complications associated with central venous catheterization procedures are frequent.
The aim of this study is to analyze the outcomes of echography for venous procedures in patients on periodic haemodialysis.
Methods. A hundred and twenty-two (122) procedures were performed in 101 patients on periodic haemodialysis. Punctures were performed in the internal jugular vein (IJV) previous echographic assessment of the puncture site. Many procedures (94) were guided by ecography.
Results. Sixty-six patients had normal IJV, 32 patients had only one normal IJV and 3 had both veins with thrombus. Thrombotic or small right IJV was seen in 27,7% patients while thrombotic, small or absent left IJV in 10%. Puncture procedures succeeded in 119 jugular veins. In 74,8% cases, a guided puncture by echography was performed at the first attempt, while 4,2% at the second or third attempt. Punctures were performed after identifying IJV by echography in 21,0%. One complication related to punctures occurred: the carotid artery was punctured in one case (0,8%).
Conclusions. Abnormalities in IJV were frequent in the studied group of patients. Both preceded or guided punctures were successful, and minimized complications.

References

1) Saad TF. Central venous dialysis catheters: catheter-associated infection. Semin Dial 2001; 14(6): 446-51.
2) Schwab SJ, Beathard G. The hemodialysis catheter conundrum: hate living with them, but can't live without them. Kidney Int 1999; 56(1): 1-17.
3) Aslam N, Palevsky PM. Real-Time Ultrasound for Placement of Dialysis Catheters: A New Standard of Care. Semin Dial 1999; 12: 1-4.
4) Lin BS, Kong CW, Tarng DC, Huang TP, Tang GJ. Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasono-graphic survey in uraemic patients. Nephrol Dial Transplant 1998; 13(1): 134-8.
5) Lin BS, Huang TP, Tang GJ, Tarng DCh, Kong ChW. Ultrasound-guided cannulation of the internal jugular vein for dialysis vascular access in uremic patients. Nephron 1998; 78(4): 423-8.
6) Mallory DL, McGee WT, Shawker TH, Brenner M, Bailey KR, Evans RG, et al. Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial. Chest 1990; 98(1): 157-60.
7) Troianos CA, Jobes DR, Ellison N. Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg 1991; 72(6): 823-6.
8) Denys BG, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 1993; 87(5): 1557-62.
9) Denys BG, Uretsky BF, Reddy PS, Ruffner RJ, Sandhu JS, Breishlatt WM. An ultrasound method for safe and rapid central venous access. N Engl J Med 1991; 324(8): 566.
10) Farrell J, Gellens M. Ultrasound-guided cannulation versus the landmark-guided technique for acute haemodialysis access. Nephrol Dial Transplant 1997; 12(6): 1234-7.
11) Kumwenda MJ. Two different techniques and outcomes for insertion of long-term tunnelled haemodialysis catheters. Nephrol Dial Transplant 1997; 12(5): 1013-6.
12) Denys BG, Uretsky BF. Anatomical variations of internal jugular vein location: Impact on central venous access. Crit Care Med 1991; 19(12): 1516-9.
13) Swartz RD, Messana JM, Boyer CJ, Lunde NM, Weitzel WF, Hartman TL. Successful use of cuffed central venous hemodialysis catheters inserted percutaneously. J Am Soc Nephrol 1994; 4(9): 1719-25.