NDT Advance Access originally published online on March 19, 2004
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Nephrol Dial Transplant (2004) 19: 1542-1545
Nephrol Dial Transplant Vol. 19 No. 6 © ERA-EDTA 2004; all rights reserved
Original Article
Venography at insertion of tunnelled internal jugular vein dialysis catheters reveals significant occult stenosis
1Department of Renal Medicine, Southern Derbyshire Acute Hospitals NHS Trust, Derby, UK and 2Centre for Integrated Systems Biology and Medicine, University of Nottingham, Nottingham, UK
Correspondence and offprint requests to: M. Taal, Department of Renal Medicine, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. Email: Maarten.Taal{at}sdah-tr.trent.nhs.uk
Background. Tunnelled catheters are widely used to provide vascular access for haemodialysis. Percutaneous insertion of these catheters requires large calibre tissue dilators with the potential to cause trauma to central veins, particularly if anatomical abnormalities are present.
Methods. We evaluated the use of venography to identify central vein anatomical abnormalities in 69 consecutive patients undergoing percutaneous placement of tunnelled right internal jugular vein catheters. The internal jugular vein was entered under ultrasound guidance and venography was performed prior to insertion of a guide-wire. Images were evaluated on-screen by the operator and a decision made regarding the need for additional fluoroscopy during insertion of the catheter.
Results. In 29 cases (42%), venography showed evidence of unexpected stenosis and/or angulation of the central veins of sufficient severity to warrant additional fluoroscopy during insertion of the dilators, or abandonment of the procedure. Patients who had previously had tunnelled internal jugular catheters had more than double the incidence of such abnormalities than those who had not [15/23 (65%) vs 14/46 (30%); P = 0.009]. In two patients the procedure was abandoned due to severe stenosis. No patient suffered central vein trauma or pneumothorax. There were no adverse reactions to contrast injection.
Conclusions. Venography performed immediately prior to tunnelled internal jugular dialysis catheter insertion detects unexpected, clinically significant anatomical abnormalities of the central veins in a substantial proportion of patients, particularly those with a history of previous tunnelled catheter insertion. We suggest that the use of venography may help to minimize the risk of complications from this procedure.
Keywords: central venous catheterization; fluoroscopy; haemodialysis; internal jugular vein; tunnelled; venography
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